Systemic inflammation score predicts postoperative prognosis of patients with clear-cell renal cell carcinoma

Abstract

Background: Growing evidence indicates that inflammation has a crucial role in the development and progression of cancer. We developed a novel systemic inflammation score (SIS) based on preoperative serum albumin and lymphocyte-to-monocyte ratio (LMR), and examined its prognostic value for patients with clear-cell renal cell carcinoma (ccRCC) after surgery.

Methods: The study comprised 441 ccRCC patients undergoing nephrectomy between 2008 and 2009 in a single centre. The SIS was developed and its associations with clinicopathological features and overall survival (OS) were evaluated.

Results: The SIS consisted of serum albumin and LMR that were both retained as independent indicators adjusting for other haematological and laboratory markers of systemic inflammation responses and traditional clinicopathological features. A high SIS was significantly associated with aggressive tumour behaviours and served as an independent prognostic factor of reduced OS. Furthermore, the SIS could significantly stratify patient prognosis in different tumour stages and Mayo Clinic stage, size, grade and necrosis scores. Incorporation of the SIS into a prognostic model including TNM stage, Fuhrman grade and lymphovascular invasion generated a nomogram, which predicted accurately 3- and 5-year survival for ccRCC patients.

Conclusions: The SIS as a potentially powerful prognostic biomarker might improve traditional clinicopathological analysis to refine clinical outcome prediction for ccRCC patients after surgery.

Figure 1

Kaplan–Meier analysis for OS of ccRCC patients according to preoperative serum albumin and LMR. Kaplan–Meier analysis for OS according to (A) preoperative serum albumin, (B) preoperative LMR, (C) combination of preoperative serum albumin and LMR, and (D) SIS.

Figure 2

Kaplan–Meier analysis for OS of ccRCC patients according to SIS in different tumour stages and SSIGN scores. Kaplan–Meier analysis for OS of ccRCC patients according to SIS in (A) early-stage (TNM stage I+II), (B) advanced-stage (TNM III+IV), (C) SSIGN low-risk (score 0–3) and (D) SSIGN intermediate/high-risk (score 4–7/score ≥8).

Figure 3

Nomogram for predicting 3- and 5-year OS of ccRCC patients after surgery. (A) Nomogram for predicting 3- and 5-year OS of ccRCC patients after surgery. Calibration plot of the nomogram for (B) 3-year and (C) 5-year survival. The dashed line represents the performance of an ideal nomogram. The blue line indicates the performance of the proposed nomogram. Orange circles are sub-cohorts of the data set; X is the bootstrapped corrected estimate of nomogram with 200 resamples. Vertical bars represent 95% CI. It seems that the nomogram predicts accurately 3- and 5-year OS.