Validation of the pre-treatment neutrophil–lymphocyte ratio as a prognostic factor in a large European cohort of renal cell carcinoma patients

Background:

The neutrophil–lymphocyte ratio (NLR) has been proposed as an indicator of systemic inflammatory response. Several studies suggest a negative impact of increased NLR for patient''s survival in different types of cancer. However, previous findings from small-scale studies revealed conflicting results about its prognostic significance with regard to different clinical end points in non-metastatic renal cell carcinoma (RCC) patients. Therefore, the aim of our study was the validation of the prognostic significance of NLR in a large cohort of RCC patients.

Methods:

Data from 678 consecutive non-metastatic clear cell RCC patients, operated between 2000 and 2010 at a single centre, were evaluated retrospectively. Cancer-specific, metastasis-free, as well as overall survival (OS) were assessed using the Kaplan–Meier method. To evaluate the independent prognostic significance of NLR, multivariate Cox regression models were applied for all three different end points. Influence of the NLR on the predictive accuracy of the Leibovich prognosis score was determined by Harrell''s concordance index.

Results:

Multivariate analysis identified increased NLR as an independent prognostic factor for overall (hazard ratio (HR)=1.59, 95% confidence interval (CI)=1.10–2.31, P=0.014), but not for cancer-specific (HR=1.59, 95% CI=0.84–2.99, P=0.148), nor for metastasis-free survival (HR=1.39, 95% CI=0.85–2.28, P=0.184). The estimated concordance index was 0.79 using the Leibovich risk score and 0.81 when NLR was added.

Conclusion:

Regarding patients'' OS, an increased NLR represented an independent risk factor, which might reflect a higher risk for severe cardiovascular and other comorbidities. Adding the NLR to well-established prognostic models such as the Leibovich prognosis score might improve their predictive ability.     

Successful replantation of a totally amputated penis by using microvascular techniques

A rare case of successful replantation of a totally amputated penis is reported. By using microvascular techniques a superior result was achieved. Not only were all tissue preserved, but also urination, sensation and erection returned to normal. Specific points to be considered in penile replantation are discussed.     

Does overweight impact on the prognosis of patients with renal cell carcinoma? A single center experience of 683 patients

BACKGROUND AND OBJECTIVES: An increased incidence of renal cell carcinoma (RCC) in obese patients has been reported by several authors. We investigated the association of body mass index (BMI) with prognosis of patients with RCC. METHODS: From January 1994 to December 2000, 693 operations for RCC in 683 consecutive patients were performed at our institution. Patients' BMI at operation was evaluated, overall, tumor-specific and progression-free survival was investigated using the Kaplan-Meier method, for multivariate analysis the Cox regression model was used. RESULTS: Four hundred seventeen patients were males, 266 females. Mean age was 62 years (range 16-88). BMI was available in 609 (89.2%). 371/609 (60.9%) of patients exhibited a BMI greater than 25. After a mean follow-up of 41.5 months, 86 (12.6%) patients died from metastatic RCC, and 29 (4.3%) were alive with metastatic disease. A significant advantage regarding overall (P = 0.015) and progression-free (0.017) but not tumor-specific survival (P = 0.057) was found for patients with a BMI of more than 25 compared to normal-weight patients. In multivariate analysis, BMI showed no significant association with tumor-specific survival. CONCLUSIONS: Patients with a BMI of more than 25 had a better outcome compared to patients with normal weight in univariate analysis but not multivariate analysis.     

Findings and clinical course of a localized primitive peripheral neuroectodermal tumor of the kidney

Primitive neuroectodermal tumor (PNET) is a very aggressive neoplasm, considered to have an unfavorable prognosis, and renal location is extremely rare. We present the findings and clinical course of a patient with localized disease who is free of disease more than 3 years after first presentation. In suspicious cases we recommend to surgically explore renal masses as early as possible.     

Value of intensive thyroid assessment in male infertility

In infertile men thyroid hormone and antibody testing was performed and correlated with the results of semen analyses. Evaluation included semen analyses, physical examination, evaluation of sex steroid hormones, thyroid hormones (bTSH, fT4, fT3) and thyroid antibody testing (TGA, TPO-Ab, TRAK). Furthermore 45 men with normal thyroid function were scheduled for TRH testing. No one was diagnosed as having manifest hypo- or hyperthyroidism. Latent thyroid dysfunction had no effect on semen parameters. Elevated TPO-Ab were significantly correlated with reduction in motility of spermatozoa. The routine assessment of thyroid hormones and antibodies in infertile men is not recommended. Subclinical hypothyroidism as a result of TRH testing is a rare finding in infertile men.     

Influence of coconut water on hemostasis.

Coconut water (CNW) can be used as short-term intravenous hydration and resuscitation fluid. We investigated the influence of coconut water on plasma coagulation in vitro. Either CNW or physiological saline (PS) was added to citrated plasma of 8 healthy volunteers. Coagulation capability of diluted plasma was evaluated by thrombelastography (TEG). Replacement of up to 50 % of citrated plasma by CNW or PS did not influence initiation of coagulation as indicated by split point and reaction time, respectively. Strength of fibrin clot as expressed by maximum amplitude (MA) of TEG recording dose dependently declined in both groups. Replacing 50 % of citrated plasma by CNW or PS reduced MA by 39% and 32%, respectively. The influence of coconut water on hemostasis as assessed by TEG does not differ from the effect caused by an identical volume of PS.     

Sickness behaviour, an animal equivalent to human quality of life, is improved in septic rats by G-CSF and antibiotic prophylaxis

BACKGROUND AND AIM: New biological response modifiers are usually tested in reductionistic, pharmacological animal models by the determination of mechanistic endpoints (mortality rate, cellular/physiological parameters). In the meantime, quality of life had become an important endpoint in clinical trials but adequate animal experiments are very rare. The aim of this study was to demonstrate alterations in the behavioural response of septic rats due to a prophylaxis with cytokine (G-CSF) plus antibiotics. METHODS: Sickness behaviour (locomotor activity, circadian rhythms of blood pressure, heart rate and temperature) was determined by the use of radio telemetry. Complex animal experiments in rats were performed including anaesthesia, antibiotic and G-CSF prophylaxis, volume substitution, laparotomy, contamination and infection with human faecal suspension and postoperative analgesia. RESULTS: Prior to infection, rats showed circadian rhythm in locomotor activity, blood pressure, heart rate and temperature. Sham operation did not alter these parameters significantly. Immediately after abdominal contamination and infection, locomotor activity was strongly reduced and circadian rhythm was lost in all parameters. Body temperature showed a continuous rise, peaking 38 h after infection. Untreated animals died in 63% (8/14) of cases. Antibiotic prophylaxis blunted the febrile response and markedly reduced mortality to 20% (2/10) or 0% (0/10) using G-CSF plus antibiotics. Blood pressure and heart rate were increased in parallel with the rise in temperature. These early physiological changes were not prevented by prophylaxis, but normal behaviour was restored faster with G-CSF plus antibiotic prophylaxis. CONCLUSIONS: In septic rats, sickness behaviour (locomotor activity) is significantly improved in parallel to the mortality rate by a prophylaxis with G-CSF plus antibiotics. Sickness behaviour can be considered as an equivalent to human quality of life.     

High plasma fibrinogen level represents an independent negative prognostic factor regarding cancer-specific,metastasis-free,as well as overall survival in a European cohort of non-metastatic renal cell carcinoma patients

Background:

In recent years, plasma fibrinogen has been ascribed an important role in the pathophysiology of tumour cell invasion and metastases. A relatively small-scale study has indicated that plasma fibrinogen levels may serve as a prognostic factor for predicting clinical outcomes in non-metastatic renal cell carcinoma (RCC) patients.

Methods:

Data from 994 consecutive non-metastatic RCC patients, operated between 2000 and 2010 at a single, tertiary academic centre, were evaluated. Analyses of plasma fibrinogen levels were performed one day before the surgical interventions. Patients were categorised using a cut-off value of 466 mg dl⁻¹ according to a calculation by receiver-operating curve analysis. Cancer-specific (CSS), metastasis-free (MFS), as well as overall survival (OS) were assessed using the Kaplan–Meier method. To evaluate the independent prognostic impact of plasma fibrinogen level, a multivariable Cox regression model was performed for all three different endpoints.

Results:

High plasma fibrinogen levels were associated with various well-established prognostic factors, including age, advanced tumour stage, tumour grade and histologic tumour necrosis (all P<0.05). Furthermore, in multivariable analysis, a high plasma fibrinogen level was statistically significantly associated with a poor outcome for patients'' CSS (hazard ratio (HR): 2.47, 95% confidence interval (CI): 1.49–4.11, P<0.001), MFS (HR: 2.15, 95% CI: 1.44–3.22, P<0.001) and OS (HR: 2.48, 95% CI: 1.80–3.40, P<0.001).

Conclusion:

A high plasma fibrinogen level seems to represent a strong and independent negative prognostic factor regarding CSS, MFS and OS in non-metastatic RCC patients. Thus, this easily determinable laboratory value should be considered as an additional prognostic factor for RCC patients'' individual risk assessment.