Neutrophil-lymphocyte ratio in the management and prediction of outcomes in renal cell carcinoma

Table 1 Summary of key studies on the association of neutrophil-lymphocyte ratio and clinical outcomes of patients with renal cell carcinoma

References	Type of study	Study numbers (patient numbers)	Main findings
Hu et al[15]	Meta-analysis	15 (3357)	Elevated pretreatment NLR was significantly associated with reduced OS (HR: 1.82; 95%CI: 1.51-2.19; P < 0.001) and RFS/PFS (HR: 2.18; 95%CI: 1.75-2.71; P < 0.001) in RCC
Luo et al[16]	Meta-analysis	13 (3684)	Elevated pretreatment NLR was significantly associated with reduced OS (HR: 1.79; 95%CI: 1.51-2.00; P < 0.00001), RFS (HR: 1.97; 95%CI: 1.37-2.84; P = 0.0003) and PFS (HR: 1.85; 95%CI: 1.24-2.77; P = 0.003). However, NLR was not associated with CSS
Boissier et al[17]	Meta-analysis	15 (3512)	Higher pretreatment NLR was significantly associated with reduced OS in locally advanced or metastatic RCC (HR: 1.55; 95%CI: 1.36-1.76; P < 0.00001). In localized RCC, an elevated NLR was associated with reduced PFS
Na et al[23]	Meta-analysis	9 (1091)	In patients with metastatic RCC receiving tyrosine kinase inhibitors, elevated pretreatment NLR was associated with reduced OS (HR: 1.93; 95%CI: 1.35-2.77; P = 0.0003) and PFS (HR: 2.12; 95%CI: 1.42-3.17; P = 0.0002)
Grimes et al[18]	Systematic review	4 (2474)	All studies found an elevated NLR to be associated with a poorer prognosis in RCC. Elevated NLR were associated with a lower PFS, lower CSS (HR: 1.02, P = 0.009) and lower OS (HR: 1.02-1.6)

CI: Confidence interval; CSS: Cancer-specific survival; HR: Hazard ratio; NLR: Neutrophil-lymphocyte ratio; PFS: Progression-free survival; OS: Overall survival; RCC: Renal cell carcinoma; RFS: Recurrence-free survival.