Prognostic Value and Model Construction of Preoperative Inflammatory Markers in Patients with Metastatic Renal Cell Carcinoma

Abstract Purpose: Inflammation is considered to be one of the driving factors of cancer, and chronic inflammation plays a crucial role in tumor growth and metastasis. In this study, the aim was to study the predictive value of preoperative inflammatory biomarkers including preoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and aspartate aminotransferase-to-lymphocyte ratio (ALR) which was a novel inflammatory biomarker, for overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC). Method: This study included a total of 198 patients with mRCC from a single center from 2006 to 2022. The optimal cut-off levels of the three biomarkers were calculated by using the receiver operating characteristic curve (ROC). The patients were divided into two groups (high and low values) according to the cut-off level, and the difference between them was analyzed and compared by the Kaplan-Meier curve. Cox univariate and multivariate analyzes were used to assess independent prognostic inflammatory biomarkers. Finally, independent prognostic inflammatory biomarkers were incorporated into the prognostic model to establish a nomogram to predict the postoperative survival of patients with mRCC. Result: The optimal cut-off level of NLR evaluated by the ROC curve was 3.836, LMR was 3.106, and ALR was 68.056. Patients with NLR and ALR higher than the cut-off level and LMR lower than the cut-off level were significantly related to OS. Multivariate analysis showed that lower LMR and higher ALR were independent risk factors for OS. In addition, a nomogram can accurately predict the OS in patients with mRCC. Conclusion：ALR and LMR are independent risk factors for the prognosis of patients with mRCC. By monitoring ALR and LMR after operation, the prognosis of patients with mRCC can be better evaluated.