Yu Zhao,1,* Yina Ma,1,* Wenhui Zhang,2 Binbin Jiao,1 Yuanhao Chen,1 Gao Li,1 Xin Zhang1 

1Department of Urology Surgery, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, Beijing, People’s Republic of China; 2Department of Hepatobiliary Surgery, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, Beijing, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xin Zhang, Email zhangxin19731@hotmail.com

Objective: The aim of this study was to evaluate the impact of preoperative platelet lymphocyte ratio (PLR) on the prognosis of patients after radical nephrectomy (RNU).
Methods: We retrospectively analyzed clinical data from 226 patients without a history of bladder cancer who underwent RNU at Beijing Chaoyang Hospital, Capital Medical University between January 2009 and December 2020. Patients were stratified into two groups (A low PLR group (n = 174) and a high PLR group (PLR ≥ 169.4) based on an optimal PLR threshold (PLR=169.4). The predictive accuracy of inflammatory biomarkers was assessed using receiver operating characteristic curves. Univariate and multivariate Cox proportional risk analyses were used to estimate the effect of PLR on intravesical recurrence-free survival (IVRFS), recurrence-free survival (RFS), and overall survival (OS). The effect of PLR on IVRFS, RFS and OS was further examined using Kaplan-Meier survival curve analysis.
Results: The study cohort comprised 226 individuals with a mean age of 67.2 ± 9.8, 113 (50%) males and 113 (50%) females, 68 (30.1%) low-grade tumors and 158 (69.9%) high-grade tumors. In this study, 81 patients (36.7%) relapsed and 73 patients (32.3%) died. The area under the curve for PLR prediction of IVRFS was 0.603, superior to other inflammatory biomarkers. Multivariate analysis showed that PLR > 169.4 independently increased the risk of IVR after RNU, resulting in lower IVRFS [2.028 (1.014– 4.057), P = 0.046], RFS [1.900 (1.168– 3.090), P = 0.010], and OS [1.866 (1.099– 3.167), P = 0.021]. In addition, survival analysis showed lower IVRFS [8.815 (62.722– 97.278), P = 0.007], RFS [12.084 (44.315– 91.685), P = 0.003] and OS RFS [10.165 (62.077– 101.923), P = 0.005] in the low PLR group.
Conclusion: Elevated preoperative PLR is strongly associated with prognosis in patients with upper urothelial carcinoma (UTUC) after RNU without a history of bladder cancer.

Keywords: platelet-lymphocyte ratio, upper urinary tract uroepithelial carcinoma, intravesical recurrence, radical nephroureterectomy