Pre-operative Plateletcrit vs. Neutrophil to Lymphocyte Ratio in Predicting Biological Tumor Behavior in Patients with T1 - 4, N0, M0 Renal Cell Carcinoma: A Retrospective Analysis

Background: Renal cell carcinoma (RCC) is an aggressive cancer prevalent worldwide. Objectives: We investigated whether preoperative serum levels of plateletcrit (PCT) can predict tumor stages and pathological grades in patients, who were operated on for T1 - 4, N0, and M0 RCC. Additionally, we compared it with neutrophil to lymphocyte ratio (NLR). Methods: We conducted a retrospective evaluation of 196 patients, who had undergone nephrectomy (radical or partial) for T1 v- 4, N0, and M0 RCC at our hospital from January 2016 to December 2022. Based on their histopathology results, tumor stages (T) and WHO-ISUP grades (G) were identified. The patients were separated into two categories depending on their T-stage (T1 - T2 and T3 - T4) and pathological grade (G1 - 2 and G3 - 4). The study compared the NLR, PCT, and their combined values to determine their role in predicting aggressiveness based on pathological stage and grade of tumors. Results: The mean cut-off values for NLR and PCT were found to be 2.108 and 0.273, for the high tumor stage and 2.237 and 0.252 for high-grade tumors, respectively. The statistical analysis showed that NLR (P = 0.031) and PCT (P = 0.006) were significant predictors of high tumor stage, while only PCT (P = 0.022) was a significant predictor of high WHO-ISUP grade. The combination of both NLR and PCT helps improve the sensitivity for detecting high-grade tumors. Conclusions: NLR and PCT can be predictive markers of the tumor stage. However, only PCT can predict the tumor grade in patients with RCC. In addition, combining the PCT and NLR scores improved the predictive ability of each parameter, especially for identifying high-grade tumors.