Prognostic value of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma treated with first-line and subsequent second-line targeted therapy: A proposal of the modified-IMDC risk model |
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| Authors: | Nobuyuki Tanaka Ryuichi Mizuno Yota Yasumizu Keiichi Ito Suguru Shirotake Ayako Masunaga Yujiro Ito Yasumasa Miyazaki Masayuki Hagiwara Kent Kanao Shuji Mikami Ken Nakagawa Tetsuo Momma Takeshi Masuda Tomohiko Asano Masafumi Oyama Mototsugu Oya |
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| Institution: | 1. Department of Urology, Keio University School of Medicine, Tokyo, Japan;2. Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan;3. Department of Urology, National Defense Medical College, Tokorozawa, Japan;4. Department of Urology, Saiseikai Central Hospital, Tokyo, Japan;5. Department of Urology, Saitama City Hospital, Saitama, Japan;6. Department of Urology, National Hospital Organization Saitama Hospital, Wako, Japan;7. Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Japan;8. Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan;9. Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan |
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| Abstract: | PurposeThe International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk model has been designed for prognostification in patients with metastatic renal cell carcinoma (mRCC) treated with targeted therapy. One factor is neutrophil count; however, increasing evidence has suggested the superiority of neutrophil-to-lymphocyte ratio (NLR) for predicting outcome. In this study, we evaluate the prognostic effect of NLR levels on patients with mRCC treated with targeted therapy, and then we compare the predictive accuracy of the IMDC risk model and its modified one by using NLR, instead of neutrophil count.Patients and methodA total of 277 patients are included for the analysis. All patients underwent targeted therapies and associated outcome are assessed using multivariate analysis.ResultsPretreatment NLR levels are elevated in 30.3% and 23.1% of patients in the first-line and subsequent second-line setting, respectively. Kaplan-Meier curves reveal that elevated pretreatment NLR is significantly associated with poor overall survival (OS) since first-line (P<0.001) and second-line targeted therapy administration (P<0.001). Also, multivariate analyses show that elevated pretreatment NLR is an independent predictor for poor OS since first-line and second-line targeted therapy administration. The addition of NLR to the IMDC risk model, instead of neutrophil count, significantly improves the predictive accuracy for OS, and estimated gain is 1.7% and 6.2% in first-line and second-line targeted therapy, respectively.ConclusionChanges in NLR levels could be predictive for prognosis in patients with mRCC treated with first-line and second-line targeted therapy. The addition of NLR significantly improves the predictive accuracy of the IMDC risk model in the first-line and subsequent second-line setting. |
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| Keywords: | Renal cell carcinoma Targeted therapy Metastasis Outcome Prognosis Neutrophil NLR |
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