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Annals of Surgical Oncology

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The CANLPH Score, an Integrative Model of Systemic Inflammation and Nutrition Status (SINS), Predicts Clinical Outcomes After Surgery in Renal Cell Carcinoma: Data From a Multicenter Cohort in Japan

Kazumasa Komura MD, PhD, Takeshi Hashimoto MD, PhD, Takuya Tsujino MD, Ryu Muraoka MD, Takeshi Tsutsumi MD, Naoya Satake MD, PhD, Tomohisa Matsunaga MD, Yuki Yoshikawa MD, Tomoaki Takai MD, PhD, Koichiro Minami MD, PhD, Kohei Taniguchi MD, PhD, Hirofumi Uehara MD, Tomohito Tanaka MD, PhD, Hajime Hirano MD, PhD, Hayahito Nomi MD, PhD, Naokazu Ibuki MD, PhD, Kiyoshi Takahara MD, PhD, Teruo Inamoto M
Urologic Oncology
Volume 26, Issue 9 / September , 2019



A myriad of studies have demonstrated the clinical association of systemic inflammatory and nutrition status (SINS) including C-reactive protein/albumin ratio (CAR), the neutrophil/lymphocyte ratio (NLR), and the platelet/hemoglobin ratio (PHR). This study aimed to investigate the predictive value of the score integrating these variables (CANLPH) in patients with renal cell carcinoma (RCC).


Using cohort data from a multi-institutional study, 757 of 1109 patients were retrospectively analyzed. The optimal cutoff value for outcome prediction of continuous variables in CAR, NLR, and PHR was determined and the CANLPH score was then calculated as the sum score of 0 or 1 by the cutoff value in each ratio.


The median follow-up time was 76 months for the patients who survived (n = 585) and 31 months for those who died (n = 172). The Youden Index offered an optimal cutoff of 1.5 for CAR and 2.8 for NLR, and a higher value from the cutoff was assigned as a score of 1. The cutoff value of the PHR was defined as 2.1 for males and 2.3 for females. The patients were assigned a CANLPH score of 0 (47.2%), 1 (31.3%), 2 (13.1%), or 3 (8.5%). In the multivariate analysis, the CANLPH score served as an independent predictor of cancer-specific mortality in both localized and metastatic RCC.


The score was well-correlated with clinical outcome for the RCC patients. Because this score can be concisely measured at the point of diagnosis, physicians may be encouraged to incorporate this model into the treatment for RCC.

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