A comparative analysis of clinicopathological characteristics and surgical outcomes in adults with renal masses

Background: The management of renal masses varies significantly across age groups, necessitating a comprehensive understanding of age-related clinicopathological characteristics. This study evaluates these characteristics and surgical outcomes in patients aged ≤45 years versus >45 years. Aim: The aim of the study was to evaluate the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR), patient age, tumor-node-metastasis (TNM) stage, and long-term survival in renal cell carcinoma (RCC), and to assess whether NLR can improve risk stratification beyond conventional clinicopathologic factors. Materials and Methods: A retrospective analysis of 199 patients with renal space-occupying lesions was conducted between January 2018 and December 2024. Patients were stratified by age (≤45 years: n = 64; >45 years: n = 135). Demographics, clinical presentations, histopathology, surgical approaches, and perioperative parameters were analyzed using appropriate statistical methods. Results: Older patients more frequently experienced flank pain (76.4% vs. 58.1%) and hematuria (50.3% vs. 34.4%), and had higher nodal (N1: 9 vs. 1) and metastatic (M1: 28 vs. 2) disease rates compared to those ≤45 years. Clear-cell RCC remained most common (43.2% across groups). Postoperative creatinine rose significantly in all nephrectomy types, whereas hemoglobin changes were similar by age. Preoperative NLR increased with pT stage ( P < 0.001), was higher in node-positive ( P = 0.030) and metastatic ( P < 0.001) cases, underscoring its independent prognostic value across age strata. Conclusions: Age significantly influences the clinical presentation and disease stage of renal masses. Histologic subtypes were similar across ages, but older patients consistently had more advanced disease. Moreover, elevated preoperative NLR was strongly linked to higher TNM stage, underscoring its value in RCC risk stratification.