Inflammation-based prognostic markers in renal cell carcinoma: insights from a 15-year experience

Renal cell carcinoma (RCC) represents nearly 90% of kidney cancers. With improvements in treatment and longer survival, reliable prognostic markers are increasingly important. This study investigated the prognostic value of systemic inflammatory markers and clinicopathological features in RCC patients undergoing nephrectomy.

We retrospectively analyzed 418 patients who underwent radical or partial nephrectomy for RCC between 2009 and 2024. Preoperative hematologic markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammatory response index (SIRI), and systemic immune-inflammation index (SII), were evaluated. Their associations with overall survival (OS) and recurrence-free survival (RFS) were assessed using survival analyses and multivariate Cox regression.

The cohort had a median age of 60.5 years and a median follow-up of 72.3 months. Elevated NLR, PLR, SIRI, SII, and reduced LMR were associated with worse OS and RFS. On multivariate analysis, age > 64.5 years, higher tumor grade, NLR ≥ 2.93, and LMR < 3.67 independently predicted poorer OS.

Simple, routinely available preoperative inflammatory markers, particularly NLR and LMR, may serve as useful predictors of survival in RCC patients.