A Systematic Review of the Prognostic Role of Hematologic Scoring Systems in Patients With Renal Cell Carcinoma Undergoing Nephrectomy With Curative Intent

Abstract

The objective is to evaluate the prognostic benefit of the Glasgow Prognostic Score (GPS), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and Prognostic Nutrition Index (PNI) in patients with localized renal cell carcinoma undergoing nephrectomy with curative intent. Embase and MEDLINE databases were searched for all publications before April 2015. Duplicates were excluded, and inclusion/exclusion criteria were applied to all abstracts; of those remaining, full articles were obtained and inclusion/exclusion criteria were again applied, and the remaining articles were included and critically appraised. Eight articles were included in this review. Three articles were included for GPS. Outcomes included recurrence-free survival, cancer-specific survival (CSS), and overall survival (OS). All articles demonstrated better prognosis associated with a lower GPS on multivariate analysis: 1-year recurrence-free survival hazard ratio (HR), 7.0 (P = .001); CSS HR, 6.7 to 8.6 (P < .001); and OS HR 4.2 (P < .001). Four articles were included for NLR. All articles demonstrated elevated NLR to be associated with a poorer prognosis. Two articles demonstrated elevated NLR to be associated with a lower progression-free survival. One article demonstrated elevated NLR to be associated with a lower CSS (HR, 1.02, P = .009), and 2 articles demonstrated elevated NLR to be associated with a lower OS (HR, 1.02-1.6). No articles were included for PLR, and only 1 article was identified for PNI. There may be a role for modified GPS and NLR in patients with renal cell carcinoma undergoing nephrectomy with curative intent. Evidence for PLR and PNI is minimal.

Keywords: Glasgow Prognostic Score; Modified Glasgow Prognostic Score; Neutrophil-lymphocyte ratio; Platelet–lymphocyte ratio; Prognostic Nutrition Index; Renal cell carcinoma.