{ "abstract": "Background: Systemic inflammation is associated with the prognosis of clear cell renal cell carcinoma (ccRCC). The C-reactive protein-to-lymphocyte ratio (CLR) combines systemic inflammation and host immune status. However, its prognostic value in non-metastatic ccRCC remains unclear. This study evaluated the association between preoperative CLR and survival outcomes in patients with non-metastatic ccRCC. Methods: We retrospectively included 414 patients with non-metastatic ccRCC who underwent partial or radical nephrectomy. The primary Cox analyses treated ln(CLR) as a continuous variable and assessed overall survival (OS) and the cause-specific hazard of ccRCC-related death. Sensitivity analyses included expanded adjustment and time-varying effects. Cut-off-based analyses were exploratory. Time-dependent receiver operating characteristic curves were used to compare CLR with other inflammatory markers. Incremental discrimination and calibration were assessed using bootstrap internal validation. Results: After adjustment for age, Fuhrman grade, and T stage, ln(CLR) remained independently associated with OS (HR = 1.589, 95% CI 1.257–2.009; P < 0.001) and ccRCC-related death (HR = 1.612, 95% CI 1.266–2.052; P < 0.001). The associations persisted in sensitivity analyses addressing additional pathological factors and time-varying effects. The 3- and 5-year AUCs of CLR for OS were 0.810 and 0.776, respectively. No statistically significant AUC differences were detected between CLR and CRP, NLR, or CAR. Adding CLR increased the apparent C-index from 0.843 to 0.885. After bootstrap optimism correction, the C-indices were 0.832 and 0.873, respectively (ΔC-index = 0.041). Calibration was assessed at 3 and 5 years. Conclusions: Preoperative CLR was independently associated with OS and the cause-specific hazard of ccRCC-related death in this single-center cohort. Adding CLR improved discrimination after internal validation, but its superiority over other inflammatory markers and clinical utility remain unestablished. Independent multicenter validation is needed.", "abstract_shown": true, "affiliations": [ "Department of Urology, Jincheng People's Hospital, Jincheng, Shanxi Province, China.", "Department of Urology, Sir Run Run Hospital Nanjing Medical University, Nanjing, Jiangsu Province, China.", "Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China." ], "article_type": "Research Article", "arxiv": null, "author_total": 6, "authors": [ { "affs": [ 0 ], "name": "Minchao Qin" }, { "affs": [ 0 ], "name": "Zhongwen Feng" }, { "affs": [ 0 ], "name": "Chao Zhang" }, { "affs": [ 0 ], "name": "Wei Song" }, { "affs": [ 1 ], "name": "Kai Wang" }, { "affs": [ 2 ], "name": "Zhen Chen", "orcid": "0000-0003-2153-1268" } ], "bibtex": "https://research.draconitic.com/paper/dwszz66q9yjf9.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0362126", "fulltext_url": "https://europepmc.org/articles/PMC13722192", "id": "dwszz66q9yjf9", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0362126", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Animal Cells" ], [ "heading", "Biochemistry" ], [ "heading", "Biology and Life Sciences" ], [ "heading", "Blood Cells" ], [ "heading", "C-Reactive Proteins" ], [ "heading", "Cancers and Neoplasms" ], [ "heading", "Carcinoma" ], [ "heading", "Cell Biology" ], [ "heading", "Cellular Types" ], [ "heading", "Clinical Medicine" ], [ "heading", "Genitourinary Tract Tumors" ], [ "heading", "Immune Cells" ], [ "heading", "Immune Response" ], [ "heading", "Immunology" ], [ "heading", "Inflammation" ], [ "heading", "Lymphocytes" ], [ "heading", "Medicine and Health Sciences" ], [ "heading", "Necrosis" ], [ "heading", "Nephrology" ], [ "heading", "Oncology" ], [ "heading", "Proteins" ], [ "heading", "Renal Cancer" ], [ "heading", "Renal Cell Carcinoma" ], [ "heading", "Research Article" ], [ "heading", "Signs and Symptoms" ], [ "heading", "Surgical and Invasive Medical Procedures" ], [ "heading", "White Blood Cells" ], [ "plos", "/Biology and life sciences/Biochemistry/Proteins/C-reactive proteins" ], [ "plos", "/Biology and life sciences/Cell biology/Cellular types/Animal cells/Blood cells/White blood cells/Lymphocytes" ], [ "plos", "/Biology and life sciences/Cell biology/Cellular types/Animal cells/Immune cells/White blood cells/Lymphocytes" ], [ "plos", "/Biology and life sciences/Immunology/Immune cells/White blood cells/Lymphocytes" ], [ "plos", "/Biology and life sciences/Immunology/Immune response/Inflammation" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Inflammation" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Necrosis" ], [ "plos", "/Medicine and health sciences/Immunology/Immune cells/White blood cells/Lymphocytes" ], [ "plos", "/Medicine and health sciences/Immunology/Immune response/Inflammation" ], [ "plos", "/Medicine and health sciences/Nephrology/Renal cancer" ], [ "plos", "/Medicine and health sciences/Oncology/Cancers and neoplasms" ], [ "plos", "/Medicine and health sciences/Oncology/Cancers and neoplasms/Carcinoma/Renal cell carcinoma" ], [ "plos", "/Medicine and health sciences/Oncology/Cancers and neoplasms/Genitourinary tract tumors/Renal cell carcinoma" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures" ] ], "openalex": null, "pdf_url": "https://europepmc.org/articles/PMC13722192?pdf=render", "pmcid": "PMC13722192", "pmid": "42961929", "published": "2026-10-30", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/dwszz66q9yjf9.ris", "sources": [ { "first_seen": "2026-10-31T12:20:55Z", "native_id": "10.1371/journal.pone.0362126", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0362126" }, { "first_seen": "2026-11-02T03:21:21Z", "native_id": "MED:42961929", "source": "europepmc", "url": "https://europepmc.org/article/MED/42961929" }, { "first_seen": "2026-11-03T12:22:45Z", "native_id": "PMC13722192", "source": "pmc", "url": "https://doi.org/10.1371/journal.pone.0362126" } ], "subjects": [ { "field": "biochemistry", "origin": "heading:Biochemistry", "subfield": "general" }, { "field": "biology", "origin": "plos:cell biology", "subfield": "cell-biology" }, { "field": "biology", "origin": "plos:immunology", "subfield": "immunology" }, { "field": "medicine", "origin": "plos:cancers and neoplasms", "subfield": "oncology" }, { "field": "medicine", "origin": "heading:Surgical and Invasive Medical Procedures", "subfield": "surgery" } ], "title": "Prognostic value of the preoperative C-reactive protein-to-lymphocyte ratio in patients with non-metastatic clear cell renal cell carcinoma", "title_text": "Prognostic value of the preoperative C-reactive protein-to-lymphocyte ratio in patients with non-metastatic clear cell renal cell carcinoma", "type": "peer-reviewed", "updated_at": "2026-11-03T12:22:45Z", "url": "https://research.draconitic.com/paper/dwszz66q9yjf9", "venue": "PLOS One", "versions": [] }