Prognostic Value of Systemic Inflammatory Biomarkers in Patients with Metastatic Renal Cell Carcinoma
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ORIGINAL ARTICLE
Prognostic Value of Systemic Inflammatory Biomarkers in Patients with Metastatic Renal Cell Carcinoma Guilherme Nader Marta 1 & Pedro Isaacsson Velho 2,3 & Renata R. C. Bonadio 1 & Mirella Nardo 1 & Sheila F. Faraj 1 & Manoel Carlos L. de Azevedo Souza 1 & David Q. B. Muniz 1 & Diogo Assed Bastos 1 & Carlos Dzik 1 Received: 29 February 2020 / Accepted: 10 June 2020 # Arányi Lajos Foundation 2020
Abstract Metastatic renal cell carcinoma (mRCC) encompasses a heterogeneous group of neoplasms with distinct clinical behavior and prognoses. As a result of the increasing number of therapeutic options in the metastatic setting, it is crucial to improve prognostic stratification ability. We aimed to evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and combination platelet count and neutrophil lymphocyte ratio (COP-NLR) in patients with mRCC. We evaluated a cohort of mRCC patients treated with first-line pazopanib or sunitinib. Levels of NLR, PLR and COP-NLR were measured prior to systemic treatment and evaluated as prognostic predictors. Primary endpoint was overall survival (OS). Data from 276 patients were included, of which 54.7% received first-line pazopanib and 45.3%, sunitinib. Memorial Sloan-Kettering Cancer Center risk classification was intermediate and poor in 50% and 42.6% of patients, respectively. High NLR (> 3.5) was associated with inferior OS (median 9.6 vs 17.8 months, P < 0.001). A high PLR (> 200) was associated with inferior OS (median 10.3 vs 17 months, P = 0.002). The median OS in the COP-NLR 1, 2 and 3 groups were 19.0 months (95% CI 15.3–26.0), 13.1 months (95% CI 9.8–17.0) and 7.4 months (95% CI 3.6–11.9), respectively (P < 0.001). In the multivariate analysis, high NLR and high COP-NLR were associated with inferior OS. Both high NLR and high COP-NLR were associated with poorer OS in our cohort of patients with mRCC treated with first-line pazopanib or sunitinib. Keywords Renal cell carcinoma . Pazopanib . Sunitinib . Neutrophil-to-lymphocyte ratio . Platelet-to-lymphocyte ratio
Introduction Renal cell carcinoma (RCC) represents 2–3% of all malignancies in adults, being responsible for 65,340 new cases and 14,970 deaths in 2018 in the United States [1]. Despite the
increase in incidence over the past decades [2], five-year survival rates have increased from 34% in 1954 to 76% in 2009 [3], certainly because of developments in local and systemic therapies. The incorporation of VEGF targeted therapies and immune checkpoint inhibitors in the therapy of RCC has improved
* Guilherme Nader Marta [email protected]
David Q. B. Muniz [email protected]
Pedro Isaacsson Velho [email protected]
Diogo Assed Bastos [email protected]
Renata R. C. Bonadio [email protected]
Carlos Dzik [email protected]
Mirella Nardo [email protected]
1
Instituto do Cancer do Estado de Sao Paulo, Av. Dr. Arnaldo, 251, Sao Paulo, SP 01246-000, Brazil
Sheila F. Faraj [email protected]
2
Manoel Carlo
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