Preoperative Lymphocyte to Monocyte Ratio as a Predictor of Prognosis for Patients Treated with Resection of Renal Cell Carcinoma with Venous Tumor Thrombus

Abstract Objectives: To evaluate the prognostic value of preoperative lymphocyte to monocyte ratio (LMR) in patients with renal cell carcinoma and venous tumor thrombus (RCC-VTT) after surgery. Methods: We retrospectively reviewed the medical data of 144 consecutive patients with RCC and level I-IV VTT after surgery. Kaplan-Meier method was used to assess and compare survival. Univariable and multivariable Cox proportional hazard models were constructed to identify the independent prognostic factor for survival. The Harrell concordance index was used to assess the predictive accuracy. Results: Decreased preoperative LMR was significantly correlated with clinicopathologic features that are associated with tumor progression. Decreased preoperative LMR was an independently risk factor for decreased OS (P < 0.05) and PFS (P < 0.05). To evaluate PFS, integrating LMR to each model led to an increased predictive accuracy of 6.9% for TNM staging model (P = 0.014), 6.8% for UISS model (P = 0.006), 3.4% for SSIGN model (P = 0.017), respectively. Incorporating LMR into SSIGN model led to an increased predictive accuracy of 6.5% for OS (P < 0.001). Conclusions: Preoperative LMR is an independent prognostic factor for patients with RCC-VTT after surgery. Adding preoperative LMR to the prognostic models enhance their predictive accuracy.