Minchao Qin, Zhongwen Feng, Chao Zhang, Wei Song, Kai Wang, Zhen Chen
Preoperative NHR and MHR were independent prognostic factors for OS and CSS in patients with non-metastatic ccRCC. Although they provided additional risk stratification beyond conventional clinicopathological factors, their clinical utility requires further validation in multicenter cohorts.
BACKGROUND: To investigate the prognostic significance of preoperative inflammatory cell-to-high-density lipoprotein cholesterol (HDL-C) ratios in patients with non-metastatic clear cell renal cell carcinoma (ccRCC) undergoing surgery.
METHODS: A total of 308 patients with non-metastatic ccRCC who underwent radical or partial nephrectomy between 2003 and 2012 were retrospectively enrolled. Preoperative neutrophil-to-HDL-C ratio (NHR), monocyte-to-HDL-C ratio (MHR), platelet-to-HDL-C ratio (PHR), and lymphocyte-to-HDL-C ratio (LHR) were calculated from peripheral blood tests. Time-dependent ROC analyses were performed to compare the prognostic discrimination of these markers for overall survival (OS) and cancer-specific survival (CSS). Kaplan-Meier analysis and Cox proportional hazards regression were used to evaluate survival associations. The incremental prognostic value of NHR and MHR beyond clinicopathological factors was assessed using C-index and decision curve analysis (DCA).
RESULTS: Among the four biomarkers, NHR and MHR demonstrated more consistent prognostic discrimination for OS and CSS than PHR and LHR. Patients with high NHR or high MHR had significantly worse OS and CSS (all log-rank P < 0.0001). After adjustment for age, Fuhrman grade, and T stage, both ln-NHR and ln-MHR remained independently associated with poorer OS and CSS (all P < 0.001). Bootstrap resampling demonstrated stable cutoff estimates for NHR and MHR. Incorporation of NHR or MHR into clinicopathological models improved model discrimination and net benefit; however, the incremental prognostic gain was modest.
CONCLUSIONS: Preoperative NHR and MHR were independent prognostic factors for OS and CSS in patients with non-metastatic ccRCC. Although they provided additional risk stratification beyond conventional clinicopathological factors, their clinical utility requires further validation in multicenter cohorts.