Nobuyuki Tanaka1, Ryuichi Mizuno2, Yota Yasumizu3, Keiichi Ito4, Suguru Shirotake3, Ayako Masunaga4, Yujiro Ito5, Yasumasa Miyazaki6, Masayuki Hagiwara7, Kent Kanao8, Shuji Mikami9, Ken Nakagawa7, Tetsuo Momma10, Takeshi Masuda11, Tomohiko Asano4, Masafumi Oyama3, Mototsugu Oya6. 1. Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saitama City Hospital, Saitama, Japan. Electronic address: urotanaka@gmail.com. 2. Department of Urology, Keio University School of Medicine, Tokyo, Japan. Electronic address: mizunor@z7.keio.jp. 3. Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan. 4. Department of Urology, National Defense Medical College, Tokorozawa, Japan. 5. Department of Urology, Saiseikai Central Hospital, Tokyo, Japan. 6. Department of Urology, Keio University School of Medicine, Tokyo, Japan. 7. Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Japan. 8. Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan. 9. Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan. 10. Department of Urology, National Hospital Organization Saitama Hospital, Wako, Japan. 11. Department of Urology, Saitama City Hospital, Saitama, Japan.
Abstract
PURPOSE: The 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 METHOD: A total of 277 patients are included for the analysis. All patients underwent targeted therapies and associated outcome are assessed using multivariate analysis. RESULTS: Pretreatment 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. CONCLUSION: Changes 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.
PURPOSE: The 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 METHOD: A total of 277 patients are included for the analysis. All patients underwent targeted therapies and associated outcome are assessed using multivariate analysis. RESULTS: Pretreatment 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. CONCLUSION: Changes 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.