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Background . The prognostic significance of the neutrophil-to-lymphocyte ratio (NLR) in nonmetastatic renal cell carcinoma (non-mRCC) is controversial, although NLR has been established as a prognostic factor in several cancers. The objective of our study was to assess the prognostic significance of preoperative NLR in non-mRCC, based on a large, multicenter cohort analysis.  Methods . Totally, 1,284 non-mRCC patients undergoing surgery were enrolled from six institutions between 2000 and 2014. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were calculated, and the prognostic significance of NLR was evaluated.  Results . Patients with higher NLR had larger tumors ( p  < 0.001), higher T stage ( p  < 0.001), worse Eastern Cooperative Oncology Group performance status ( p  < 0.001), worse symptoms ( p  = 0.003), sarcomatoid differentiation ( p  = 0.004), and tumor necrosis ( p  < 0.001). The 5-year RFS and CSS rates were significantly lower in patients with high NLR than in those with low NLR (each  p  < 0.001). Multivariate analysis identified NLR to be an independent predictor of RFS and CSS (each  p  < 0.05). Moreover, predictive accuracy of multivariate models for RFS and CSS increased by 2.2% and 4.2%, respectively, with NLR inclusion.  Conclusions . Higher NLR was associated with worse clinical behavior of non-mRCC. Also, NLR was a significant prognostic factor of both RFS and CSS.

Prognostic Significance of Preoperative Neutrophil-to-Lymphocyte Ratio in Nonmetastatic Renal Cell Carcinoma: A Large, Multicenter Cohort Analysis