Prognostic value of the preoperative C-reactive protein-to-lymphocyte ratio in patients with non-metastatic clear cell renal cell carcinoma
- 1Department of Urology, Jincheng People's Hospital, Jincheng, Shanxi Province, China.
- 2Department of Urology, Sir Run Run Hospital Nanjing Medical University, Nanjing, Jiangsu Province, China.
- 3Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China.
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.
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BibTeX
@article{qin2026prognostic,
title = {{Prognostic value of the preoperative C-reactive protein-to-lymphocyte ratio in patients with non-metastatic clear cell renal cell carcinoma}},
author = {Minchao Qin and Zhongwen Feng and Chao Zhang and Wei Song and Kai Wang and Zhen Chen},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0362126},
url = {https://doi.org/10.1371/journal.pone.0362126},
note = {CC BY},
}
RIS
TY - JOUR
TI - Prognostic value of the preoperative C-reactive protein-to-lymphocyte ratio in patients with non-metastatic clear cell renal cell carcinoma
AU - Minchao Qin
AU - Zhongwen Feng
AU - Chao Zhang
AU - Wei Song
AU - Kai Wang
AU - Zhen Chen
PY - 2026
DA - 2026/10/30
JO - PLOS One
DO - 10.1371/journal.pone.0362126
UR - https://doi.org/10.1371/journal.pone.0362126
AB - 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.
SN - 1932-6203
ER -