Neutrophil–Lymphocyte Ratio as a Prognostic Factor in Laryngeal Carcinoma

Aim of this study; investigate whether neutrophils/lymphocyte ratio (NLR) could be used as a prognostic factor in larynx cancer. The correlation between preoperative peripheral blood NLR and age, gender, smoking, alcohol use, clinical stage and differentiation degree was examined. One hundered fourty-four patients in Dicle University Department of Otorhinolaryngology between the years of 2005 and 2014 were included in the study. Clinical and preoperative laboratory data of patients were screened retrospectively from archive files of otorhinolaryngology and the pathology results were screened retrospectively from archive files of pathology. The study was approved by the local ethics committee of the department and carried out in accordance with the declaration of Helsinki as amended in 2013. Statistical analyses were performed using the SPSS 15.0 software package for Windows (SPSS inc., Chicago, IL, USA). There was a significant difference between NLR and clinical stage (p = 0.003) smoking (p = 0,001) and alcohol use (p = 0.001). When NLR was analyzed in detail according to the degree of tumor differentiation; significant differences were observed between G1 and G2 (p = 0.007) and between G1 and G3 (p = 0.001). Light of these findings, NLR is a cheap and easily accessible marker which can be used as a prognostic faxtor in laryngeal cancer. It is thougkt to shed light on the studies which will be conducted with more patients.     

Is It Possible to Improve Prognostic Classification in Patients Affected by Metastatic Renal Cell Carcinoma With an Intermediate or Poor Prognosis?

Background

The International mRCC (metastatic renal cell carcinoma) Database Consortium (IMDC) is the standard classification for mRCC. We aimed to evaluate the outcomes of a large cohort of patients with an intermediate or a poor prognosis treated with sunitinib using a different cutoff point for IMDC to improve the classification.

Neutrophil–Lymphocyte Ratio and Absolute Lymphocyte Count as Prognostic Markers in Patients Treated with Curative-intent Radiotherapy for Non-small Cell Lung Cancer

AimsThe neutrophil–lymphocyte ratio (NLR) and the absolute lymphocyte count (ALC) have been proposed as prognostic markers in non-small cell lung cancer (NSCLC). The objective of this study was to examine the association of NLR/ALC before and after curative-intent radiotherapy for NSCLC on disease recurrence and overall survival.Materials and methodsA retrospective study of consecutive patients who underwent curative-intent radiotherapy for NSCLC across nine sites in the UK from 1 October 2014 to 1 October 2016. A multivariate analysis was carried out to assess the ability of pre-treatment NLR/ALC, post-treatment NLR/ALC and change in NLR/ALC, adjusted for confounding factors using the Cox proportional hazards model, to predict disease recurrence and overall survival within 2 years of treatment.ResultsIn total, 425 patients were identified with complete blood parameter values. None of the NLR/ALC parameters were independent predictors of disease recurrence. Higher pre-NLR, post-NLR and change in NLR plus lower post-ALC were all independent predictors of worse survival. Receiver operator curve analysis found a pre-NLR > 2.5 (odds ratio 1.71, 95% confidence interval 1.06–2.79, P < 0.05), a post-NLR > 5.5 (odds ratio 2.36, 95% confidence interval 1.49–3.76, P < 0.001), a change in NLR >3.6 (odds ratio 2.41, 95% confidence interval 1.5–3.91, P < 0.001) and a post-ALC < 0.8 (odds ratio 2.86, 95% confidence interval 1.76–4.69, P < 0.001) optimally predicted poor overall survival on both univariate and multivariate analysis when adjusted for confounding factors. Median overall survival for the high-versus low-risk groups were: pre-NLR 770 versus 1009 days (P = 0.34), post-NLR 596 versus 1287 days (P ≤ 0.001), change in NLR 553 versus 1214 days (P ≤ 0.001) and post-ALC 594 versus 1287 days (P ≤ 0.001).ConclusionNLR and ALC, surrogate markers for systemic inflammation, have prognostic value in NSCLC patients treated with curative-intent radiotherapy. These simple and readily available parameters may have a future role in risk stratification post-treatment to inform the intensity of surveillance protocols.     

Could the Neutrophil to Lymphocyte Ratio be a Poor Prognostic Factor for Non Small Cell Lung Cancers?

Background: Although many prognostic factors have been identified for lung cancers, new ones are neededto determine the course of the disease. Recently, a high neutrophil to lymphocyte ratio (NLR) prior to surgeryor treatment has been shown to be an indicator of prognosis for cancer. The aim of this study was to investigatethe value of NLR as a prognostic factor and the correlation between NLR and other probable clinical prognosticfactors in non small cell lung cancer patients prior to treatment. Materials and Methods: Data of patients whowere diagnosed with non-small cell lung cancer in our institution were retrospectively reviewed. Demographicand clinicopathologic characteristics were recorded. NLR was calculated before the application of any treatment.Results: A total of 299 patients, 270 (90%) males and 29 (10%) females, were included in the study. Age (p<0.001)stage (p<0.001), Eastern Cooperative Oncology Group performance status (p<0.001), weight loss (p<0.001),anemia (p<0.001), histopatology (p<0.001), NLR ≥3 (p=0.048), NLR ≥4 (p=0.025) and NLR ≥5 (p=0.018) werefound to be the prognostic factors. Age, anemia, Eastern Cooperative Oncology Group performance status, thestage, NLR (≥5) were an independent prognostic factors. There was a positive correlation between NLR and theEastern Cooperative Oncology Group performance status (0.23, p=0.001), the C reactive protein levels (r=0.36,p<0.001). Conclusions: Prior to treatment high NLR was found as an independent poor prognosis factor. Besides,NLR correlated with Eastern Cooperative Oncology Group performance status and the C reactive protein levels.     

Does Obesity Influence the Prognosis of Metastatic Renal Cell Carcinoma in Patients Treated with Vascular Endothelial Growth Factor–Targeted Therapy?

Background.

Obesity increases the risk for renal cell carcinoma (RCC). However, it has only recently been identified as an independent positive prognostic factor for localized RCC.

Objective.

To determine whether obesity influences long-term prognosis in metastatic RCC patients receiving vascular endothelial growth factor–targeted therapy.

Design, Setting, and Participants.

In 116 patients with metastatic RCC who received antiangiogenic agents (sunitinib, sorafenib, axitinib, bevacizumab) in 2005–2010, we evaluated whether body mass index (BMI), a body surface area (BSA) above the European average, the visceral fat area (VFA), or s.c. fat area (SFA) were of predictive relevance.

Measurements.

BMI was categorized based on current World Health Organization definitions. BSA was stratified according to the European average for men (1.98 m²) and women (1.74 m²). VFA and SFA were dichotomized using the median of the observed distribution as the cutoff. The primary endpoints of this study were time to progression and overall survival time.

Results and Limitations.

The whole population had median progression-free and overall survival times of 8.3 months and 20.5 months, respectively. In contrast to BMI and BSA, higher than average VFA and SFA levels were significant predictors of longer progression-free and overall survival times. The major limitations of this study are its retrospective design and its heterogeneous patient population.

Conclusion.

This is the first study to identify high VFA and SFA levels as positive predictive biomarkers for patients who receive first-line antiangiogenic agents for metastatic RCC.     

Clinical Activity of Ipilimumab Plus Nivolumab in Patients With Metastatic Non–Clear Cell Renal Cell Carcinoma

IntroductionIpilimumab plus nivolumab has been approved for intermediate- and poor-risk metastatic renal cell carcinoma (RCC). However, the activity in non–clear cell RCC (nccRCC) is unknown.Patients and MethodsPatients from Cleveland Clinic and the University of Texas Southwestern who had received ipilimumab plus nivolumab for metastatic nccRCC from October 2017 to May 2019 were retrospectively identified. Ipilimumab plus nivolumab was administered in accordance with the CHECKMATE 214 trial. Imaging was obtained at baseline and every 12 weeks. The baseline patient characteristics, objective response per Response Evaluation Criteria in Solid Tumors, version 1.1, and treatment-related adverse events (TRAEs) per Common Terminology Criteria for Adverse Events, version 5.0, were analyzed.ResultsEighteen patients were identified. The median age was 59 years (range, 32-81 years), 77.8% were men, and the Eastern Cooperative Oncology Group performance status was 0 (38%) or 1 (50%). The median treatment duration was 2.4 months (range, 0.7-12.3 months). The non–clear cell histologic types included 6 papillary, 5 chromophobe, 3 unclassified, 2 adenocarcinoma of renal origin, 1 translocation, and 1 medullary. Most had an intermediate (66%) or poor (22%) International Metastatic Database Consortium risk. The best objective response included 6 partial responses (PRs; 33.3%) and 3 with stable disease (16.7%). Of the patients with a PR, the median time to the best response was 3.0 months, and median duration of the PR was 4.3 months. The median progression-free survival was 7.1 months. All-grade TRAEs were noted in 11 patients (61.1%) and included colitis (22%), hepatotoxicity (16%), rash (11%), and fatigue (11%). Eleven patients (61%) had TRAEs requiring high-dose glucocorticoids (> 40 mg of prednisone equivalent daily).ConclusionsIpilimumab plus nivolumab demonstrated objective responses and notable toxicity in patients with nccRCC.     

Is the Neutrophil-Lymphocyte Ratio an Indicator of Progression in Patients with Benign Prostatic Hyperplasia?

Purpose: The aim of this study was to evaluate inflammation parameters and assess the utility of the neutrophillymphocyte ratio (NLR) as a simple and readily available predictor for clinical disease activity in patients with nenign prostate hyperplasia BPH. We also aimed to investigate the relationship between inflammatory parameters with α-blocker therapy response, and evaluate the potential association between NLR and the progression of benign prostatic hyperplasia (BPH). Materials and Methods: We examined 320 consecutive patients (July 2013-December 2013) admitted to our outpatient clinic with symptoms of the lower urinary tract at Bozok University. The mean age was 60 (range, 51-75) years. Complete blood count (CBC), prostate-specific antigen (PSA), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were assessed. Correlations between PSA, CRP, ESR, prostate volume, International Prostate Symptom Score (IPPS), maximum urinary flow rate (Qmax), and NLR were assessed statistically. Patients were divided into two groups: high and low risk of progression. Results: NLR was positively correlated with IPSS (p=0.001, r=0.265), PSA (p=0.001, r=0.194), and negatively correlated with Qmax (p<0.001, r=-0.236). High-risk patients a had a higher NLR compared with low-risk patients, based on IPSS (p<0.001), PSA (p=0.013), and Qmax (p<0.001); however, there were no significant differences between the groups in terms of age (p>0.05), and prostate volume (p>0.05). Conclusions: NLR can predict BPH progression. We propose that increased inflammation is negatively associated with clinicalstatus in BPH patients and suggest that NLR can give information along with LUTS severity which may be used as a readikly accessible marker for patient follow-up.     

Phase I Trial of Sunitinib Malate plus Interferon-α for Patients with Metastatic Renal Cell Carcinoma

Background

Sunitinib malate is an oral, multitargeted tyrosine kinase inhibitor that has demonstrated superior efficacy over interferon (IFN)-α in a phase III trial in first-line, metastatic renal cell carcinoma (RCC). Herein, we report the results of a phase I dose-finding study of sunitinib in combination with IFN-α as first-line treatment in patients with metastatic RCC.

Patients and Methods

Treatment-naive patients with clear-cell metastatic RCC received sunitinib at a starting dose of 50 mg or 37.5 mg orally once daily in 6-week cycles (schedule 4/2) plus IFN-α at a starting dose of 3 MU subcutaneously 3 times a week, with weekly intrapatient dose escalation to a maximum of 9 MU as tolerated. Patients who did not tolerate either drug received lower doses of either or had dose interruptions.

Results

Twenty-five patients were enrolled; their median age was 64 years (range, 45-77 years). All patients experienced grade 3/4 treatment-emergent adverse events; the most common were neutropenia, fatigue, and thrombocytopenia. After a median of 4 cycles (range, 1-9 cycles), 3 patients (12%) had a partial response, and 20 (80%) had stable disease.

Conclusion

Although reduced starting doses were tolerated (37.5 mg for sunitinib and 3 MU for IFN-α), even these lower doses might not be well tolerated for long-term treatment of patients with metastatic RCC. Based on historical data, sunitinib on schedule 4/2 appears to be more effective as single-agent therapy. Further study of sunitinib plus IFN-α on this schedule is not being pursued in RCC.     

Are Neutrophil/Lymphocyte and Platelet/Lymphocyte Rates in Patients with Non-Small Cell Lung Cancer Associated with Treatment Response and Prognosis?

Background: Inflammation is a critical component of tumor progression. Many cancers arise from sites ofinfection, chronic irritation, and inflammation. It is now becoming clear that the tumour microenvironment,which is largely orchestrated by inflammatory cells, is an essential participant in the neoplastic process, promotingproliferation, survival and migration. Platelets can release some growth factors such as platelet-derived growthfactor, platelet factor 4, and thrombospondin. Such factors have been shown to promote hematogenous tumourspread, tumor cell adhesion and invasion, and angiogenesis and to play an important role in tumor progression.In this study, we aimed to investigate effects of the pretreatment neutrophil to lymphocyte ratio (NLR) and theplatelet to lymphocyte ratio (PLR) on survival and response to chemoradiotherapy in patients with non-small-celllung cancer (NSCLC). Materials and Methods: Ninety-four patients with non-metastatic NSCLC were includedand separated into two groups according to median valuse of NLR and PLR (low:<3.44 or high:≥3.44 andlow:<194 or high≥194, respectively). Results: Pretreatment high NLR and PLR were associated with significantlyshorter disease-free and overall survival rates. Multivariate analysis revealed that the overall survival rateswere significantly linked with PLR (OR: 1.87, CI: 1.20-2.91, p: 0.006) and response to chemoradiotherapy (OR:1.80, CI: 1.14-2.81, p: 0.012) and the disease-free survival rates were significantly associated with NLR (OR:1.81, CI: 1.16-2.82, p: 0.009) and response to chemoradiotherapy (OR: 2.30, CI: 1.45-3.66, p: 0.001). There wasno significant difference between patients with high and low NLR in terms of response to chemoradiotherapy.Similarly, there was no significant influence of the PLR. Conclusions: Pretreatment NLR and PLR measurementscan provide important prognostic results in patients with NSCLC and assessment of the two parameters togetherappears to better predict the prognosis in patients with NSCLC. The effect of inflammation, indicators of NLRand PLR, on survival seems independent of the response to chemoradiotherapy.     

Is Response to Radiotherapy in Patients Related to the Severity of Pretreatment Pain?

PURPOSE: The primary objective of this study was to determine whether there is a relationship between the severity of pretreatment pain and response to palliative radiotherapy (RT) for painful bone metastases. METHODS AND MATERIALS: The database for patients with bone metastases seen at the Rapid Response Radiotherapy Program at the Odette Cancer Center from 1999 to 2006 was analyzed. The proportion of patients with mild (scores 1-4), moderate (scores 5-6), or severe (scores 7-10) pain at baseline who experienced a complete response, partial response, stable response, or progressive response after palliative RT was determined according to International Bone Metastases Consensus definitions. RESULTS: During the 7-year study period 1,053 patients received palliative radiation for bone metastases. The median age was 68 years and the median Karnofsky performance status was 70. Of the patients, 53% had a complete or partial response at 1 month, 52% at 2 months, and 54% at 3 months post-RT. CONCLUSIONS: There was no significant difference in terms of the proportion of responders (patients with complete or partial response) and nonresponders in terms of painful bone metastases among patients presenting with mild, moderate, or severe pain. Patients with moderate pain should be referred for palliative RT.     

Evaluation of Neutrophil–Lymphocyte Ratio as a Prognostic Factor in Cervical Intraepithelial Neoplasia Recurrence

Background: Immune system status is a factor related to cervical intraepithelial neoplasia (CIN) recurrence.neutrophil-lymphocyte ratio (NLR) is a useful factor in assessing the immune status. The aim of this study was toevaluate the prognostic value of NLR factor for CIN recurrence in patient who underwent excisional procedure and itsrelationship with recurrence free survival (RFS). Methods: In this historical cohort study, a population of 307 patientswith CIN (confirmed by excisional pathology) from 2009 to 2017 were selected. NLR and hematologic factors weremeasured before surgery and the follow-up records of these patient were analyzed. The recurrence rate and RFS wereassessed during the follow-up phase. Results: The NLR cut-off point of 1.9 was determined using the Youden Index.NLRUnivariate analysis showed that higher NLR values (P<0.001), absolute neutrophilic counts (ANC) (P<0.001) andplatelet lymphocytic ratios (PLR) (P=0.002) were significantly associated with reduction in RFS. The results of Coxregression showed that removing more tissue during excision (HR = 0.325; 95% CI (0.936-0.136) significantly reducedthe hazard of recurrence, higher NLR (HR = 4.55; 95% CI) (1.97-10.51) and white blood cell (WBC) count levels (HR=1.27; 95% CI, 1.04-1.55), significantly decreased RFS, but PLR and ANC associated with RFS were not confirmedby Cox regression. Conclusion: NLR and total WBC count might be prognostic factors involved in the prediction ofrecurrence and RFS in CIN patient underwent excisional procedure. To confirm these results, more prospective studieswith larger sample sizes are needed.     

Assessment of Prognostic Value of “Neutrophil to Lymphocyte Ratio” and “Prognostic Nutritional Index” as a Sytemic Inflammatory Marker in Non-small Cell Lung Cancer

Background: Systemic inflammatory response was shown to play an important role in development andprogression of many cancer types and different inflammation-based indices were used for determining prognosis.We aimed to investigate the prognostic effects of neutrophil to lymphocyte ratio (NLR) and prognostic nutritionalindex (PNI) in patients with non-small cell lung cancer (NSCLC). Materials and Methods: NSCLC patientsdiagnosed in our institution were retrospectively reviewed. Demographic and clinicopathologic characteristicswere recorded. NLR and PNI was calculated before the application of any treatment. Results: A total of 138patients were included in the study. Patients were divided into two groups according to NLR (<3.24 or ≥3.24)and PNI (<49.5 or ≥49.5). While median overall survival was 37.0 (95% CI 17.5-56.5) months in the group withlow NLR, it was calculated as 10.0 (95%CI 5.0-15.0) months in the group with high NLR (p<0.0001). Whilemedian overall survival was 7.0 (95%CI 3.5-10.5) months in the group with low PNI, it was calculated as 33.0(95% CI 15.5-50.4) months in the group with high PNI (p<0.0001). Stage, NLR and PNI levels were evaluatedas independent risk factors for overall survival for all patients in multivariate analysis (p<0.0001, p=0.04 andp<0.001, respectively). Conclusions: NLR (≥3.24) and PNI (<49.5) at diagnosis is an independent marker ofpoor outcome in patients with NSCLC. NLR and PNI is an easily measured, reproducible prognostic tests thatcould be considered in NSCLC patients.     

Prognostic Value of P-gp and p27 in Patients with Esophageal Squamous Cell Carcinoma

Objective： To evaluate the prognostic value of P-gp and p27 expression in patients with esophageal squamous cell carcinoma （ESC）. Methods： The expressions of P-gp and p27 were detected by immunohistochemistry in 104 cases of ESC, and the clinicopathological characteristics were analyzed as well. Results： The positive rate of P-gp expression in 104 cases of ESCs was 32.7%. The positive rate of P-gp expression in the group that survived over 3 years （17.5%） was significantly lower than that in the group died within 3 years （53.3%） （x^2=14.227, P〈0.001）. The positive rate of p27 expression in 104 cases of ESCs was 67.3%. The positive rate of p27 expression in the group that survived over 3 years （75.8%） was significantly higher than that in the group died within 3 years （56.5%） （x^2=4.361, P〈0.05）. The patients with poorer differentiation whole wall invasion, lymph node metastasis and more advanced TNM stage had a shorter survival than did those with better differentiation, more superficial invasion, no lymph node involvement and earlier TNM stage; and it was statistically significant （P〈0.05）. However, tumor size, macropathologic type, age and gender had no prognostic impact on ESC patients （P〉0.05）. Conclusion： P-gp and p27 expression levels had a clinical prognostic significance in ESC. It could provide a reference basis for selecting the chemotherapy projection. The tumor differentiation degree, depth of invasion, lymph node involvement and TNM stages all were correlated to ESC patients＇ survival.     

May the Platelet to Lymphocyte Ratio be a Prognostic Factor for Epithelial Ovarian Cancer?

Background: The study aimed to evaluate changes in hematologic parameters, including white blood cell,platelet count, platelet indices, the platelet to lymphocyte and neutrophil to lymphocyte ratios in patients withearly and advanced stages of epithelial ovarian cancers. Materials and Methods: The study included 100 patientswith epithelial ovarian cancer who underwent primary staging exploratory laparotomy. Preoperative hematologicparameters, tumor histopathologic type, grade, stage and serum CA-125 levels were retrospectively analyzed.These parameters were compared between the patients with early (stage I-II) and advanced (stage III-IV) ovariancancer. Results: White blood cell count and platelet indices, including mean platelet volume, platelet distributionwidth and platelet crit did not show a statistically significant difference between groups with early and advancedovarian cancer. However, the neutrophil to lymphocyte ratio, platelet count, the platelet to lymphocyte ratioand CA-125 level showed a statistically significant difference between the two groups (p<0.05, p<0.01, p<0.001,p<0.01 respectively). Conclusions: It was found that the neutrophil to lymphocyte ratio, platelet count and theplatelet to lymphocyte ratio increased with the increasing stage of ovarian cancer. Furthermore, it was seen thatthe platelet to lymphocyte ratio is an independent prognostic factor related to the stage of epithelial ovariancancer.     

Prognostic Value of Pretreatment Albumin-to-Globulin Ratio in Patients With Non–Muscle-Invasive Bladder Cancer

Purpose

To investigate the relationship between albumin-to-globulin ratio (AGR) and oncologic outcomes in patients with non–muscle-invasive bladder cancer (NMIBC).

May the Neutrophil/Lymphocyte Ratio Be a Predictor in the Differentiation of Different Thyroid Disorders?

Background: The neutrophil/lymphocyte ratio (NLR) is a simple index of systemic inflammatory response,and has been shown to be a prognostic indicator in some types of cancer. Inflammation has been implicatedin the initiation and progression of thyroid cancer. The aim of this study was to examine the relationship ofNLR with papillary thyroid cancer (PTC) and different benign thyroid pathologies like multinodular goiter(MNG) and lymphocytic thyroiditis (LT). Materials and Methods: We retrospectively evaluated the neutrophil,lymphocyte counts and NLR calculated from these parameters of 232 patients with histologically confirmed asmultinodular goiter (group MNG) (n=70), lymphocytic thyroiditis (group LT) (n=97), LT with PTC (group LTPTC)(n=25) and PTC (group PTC) (n=40). The optimal cut-off value for NLR was determined. Results: NLRlevel was significantly higher in groups LT-PTC and PTC as compared to groups MNG and LT (p<0.05). NLRof LT subgroups according to TSH levels were not different (p>0.05). When we grouped the patients as benignand malignant according to PTC presence, the optimum NLR cut-off point obtained from ROC analysis was 1.91(sensitivity 89.0% and specificity 54.5%). Conclusions: Since NLR was significantly elevated in group LT-PTCand group PTC, NLR value may give an opinion as a potential marker in differentiation of benign and malignthyroid disorders. For this purpose a cut-off value of 1.91 for NLR may be accepted.     

Does the Time to Start First-Line Treatment Influence the Survival of Favorable-Risk Patients With Metastatic Renal Cell Carcinoma? Results of the MetaSurv–UroCCR 79 Study

Introduction and ObjectivesMany patients in the favorable International Metastatic renal cell carcinoma (RCC) Data Base Consortium group (F-MRC) may have a relatively indolent disease course. Surveillance and delay of systemic therapy could be an option in this specific population. However, the question whether this delay could alter patients’ outcome remains unanswered. Our objective was to determine if delaying first-line treatment influences the survival of F-MRC patients.Materials and MethodsWe performed a retrospective multicenter national study involving the French Network for Research on Kidney Cancer UroCCR (NCT03293563). We included treatment naive F-MRC patients. We compared the overall survival of patients with immediate medical treatment (IMT) (started less than 3 months after metastatic diagnosis) to those with delayed medical treatment (DMT).ResultsWe included 90 patients treated between 2009 and 2018. The median time before occurrence of metastases from diagnosis was 28 (12-137) months. The two groups (IMT vs. DMT) were comparable for follow-up, age, sarcomatoid feature, number, and localization of metastatic sites and ECOG performance status. IMT was given in 25 (27.8 %) patients. Local treatment of metastasis (LTM) was performed in 47 (52%) patients. Patients with DMT had more LTM (63% vs. 24%, P = .001). Among patients with DMT (n = 65); 27 (41%) received a systemic treatment and median systemic treatment-free survival was 39 months (95% CI, 26.3-51.6). Median overall survival from metastasis disease diagnosis was 55 months (95% CI, 42.4-67.5) in the IMT group and 88 months (95%CI, 64-111.9) in the DMT group (P = .028). In multivariable analysis LTM was the only prognostic factor associated to survival improvement (HR: 0.33; P = .024).ConclusionsSelected Patients with F-MRC may safely undergo DMT. LTM positively impacted survival in this population and should be considered whenever possible. Prospective trial with a larger population is needed to confirm these results.