腎腫瘤患者術前血液單核球與淋巴球比值作為術前區別腎細胞癌及良性嗜酸細胞瘤之診斷工具
林于巧、胡哲源、歐建慧
國立成功大學附設醫院 泌尿部
Preoperative Monocyte-to-lymphocyte Ratio as an Non-invasive Diagnostic Tool for Prediction of Renal Cell Carcinoma and Oncocytoma in Patients with Renal Tumor
Yu-Chiao Lin, Che-Yuan Hu, Chien-Hui Ou
Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan
Purpose:
Oncocytoma accounts for about 5% of renal neoplasms and is relatively benign. However, it is sometimes hard to distinguish oncocytoma and renal cell carcinoma (RCC) just from image like computer tomography or magnetic resonance imaging. Surgery or biopsy is often needed for pathological diagnosis, but it accompanies with risk of surgical complication like bleeding and renal function impairment. Therefore, seeking a non-invasive way to diagnose oncocytoma is important. The aim of our study was to evaluate the diagnostic value of preoperative monocyte-to-lymphocyte ratio (MLR) to differentiate oncocytoma and RCC.
Materials and Methods:
Medical records of patients receiving radical or partial nephrectomy for renal neoplasms between January 2012 and December 2019 in National Cheng Kung University Hospital were retrospectively reviewed. Patients younger than 18 years old, under an acute infectious status, having multiple renal tumors or with pathological report showing neither RCC nor oncocytoma were excluded. Baseline characteristics, preoperative laboratory data and pathological report of our patients were collected and analyzed. Optimal cut-of value of MLR was obtained through receiver operating characteristic (ROC) curve. Then Fisher’s exact test was used to evaluate of the relationship between preoperative MLR and pathological report of our patients.
Results:
Eventually 224 patients were enrolled in our study. 215 renal neoplasms were RCC and 9 were oncocytoma. Low MLR was found in patients with oncocytoma. The optimal cut-off value of preoperative MLR for prediction of oncocytoma was 0.33 (AUC=0.766, p=0.007, sensitivity 49%, specificity 88.9%) in ROC curve analysis. Patients were divided into two groups: patients with MLR higher than 0.33 (n=118) and MLR lower than 0.33 (n=106). The number of patients diagnosed of oncocytoma was 1 and 8 in above two groups accordingly. Also, patient group with higher MLR was significantly associated with increased risk of RCC in Fisher’s exact test (p=0.038).
Conclusions:
Patients with MLR higher than 0.33 had increased risk of RCC. Preoperative MLR may be used as a non-invasive diagnostic tool for renal neoplasms.