Abstract: Background and purpose: Growing evidence indicates that inflammation plays an important role in the development and progression of tumors. Preoperative lymphocyte-to-monocyte ratio (LMR) and serum albumin have been estimated as independent prognostic factors of various cancers. This study aimed to investigate the relationship between LMR or serum albumin and the prognosis of patients with clear cell renal cell carcinoma (ccRCC). Methods: Data of 147 patients who underwent radical or partial nephrectomy from 2012 to 2015 were retrospectively studied at a single tertiary academic center. Preoperative LMR and serum albumin were calculated 1 week before surgical intervention. Patients were categorized using a median value of LMR cutoff of 3.42. Dichotomization of serum albumin was according to the lower range of normal measurement at 40 g/L. The relationship between LMR or serum albumin with other clinical factors and overall survival (OS) was analyzed using univariate analysis and COX regression model. LMR and serum albumin combined with TNM stage and Fuhrman grade were used for further analysis. The influences of the LMR and serum albumin on the predictive accuracy were investigated using the Harrell concordance index. A nomogram, which predicted the 3- and 5-year survival rates for patients with ccRCC, was established by incorporating LMR and serum albumin into a prognostic model with TNM stage and Fuhrman grades. Results: LMR and serum albumin were independent prognostic factors for OS (P=0.001). Low LMR was significantly associated with high Fuhrman grade (P=0.006) and the presence of tumor necrosis (P=0.039). Low serum albumin was significantly correlated with high Fuhrman grade (P＜0.001) and high Mayo clinic stage, size, grade and necrosis (SSIGN) score (P=0.001). Multivariate analysis identified low LMR and low serum albumin as independent prognostic factors for patient’s OS (HR=0.37; 95% CI: 0.145-0.942; P=0.037; HR=0.325; 95% CI: 0.136-0.775; P=0.011). The C-index rose when LMR and serum albumin were combined with TNM stage and Fuhrman grade. A nomogram predicted the 3- and 5-year survival rates for patients with ccRCC. Conclusion: Incorporating LMR and serum albumin into traditional clinicopathological analysis can improve the predictive value for patients with ccRCC after surgery intervention.

Key words: Renal cell carcinoma, Lymphocyte-to-monocyte ratio, Serum albumin, Prognosis, Nomogram