Keiichi Ito1, Ayako Masunaga1, Nobuyuki Tanaka2,3, Ryuichi Mizuno2, Suguru Shirotake4, Yota Yasumizu4, Yujiro Ito5, Yasumasa Miyazaki2, Masayuki Hagiwara6, Kent Kanao2, Shuji Mikami7, Tetsuo Momma8, Takeshi Masuda3, Ken Nakagawa6, Masafumi Oyama4, Tomohiko Asano1, Mototsugu Oya2. 1. Department of Urology, National Defense Medical College, Saitama, Japan. 2. Department of Urology, Keio University School of Medicine, Tokyo, Japan. 3. Department of Urology, Saitama City Hospital, Saitama, Japan. 4. Department of Urology, Uro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan. 5. Department of Urology, Saiseikai Central Hospital, Tokyo, Japan. 6. Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Chiba, Japan. 7. Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan. 8. Department of Urology, National Hospital Organization Saitama Hospital, Saitama, Japan.
Abstract
OBJECTIVES: Progression-free survival of first-line targeted therapy greatly influences the survival of patients with metastatic renal cell carcinoma. We evaluated whether post-treatment inflammatory markers and lactate dehydrogenase levels had impacts on progression-free survival prediction in addition to those of conventional predictors. METHODS: Two hundred and fifteen patients whose tumors were clear cell type and in whom first-line targeted therapies could be continued for >1 month were evaluated. Pretreatment clinical factors, pathological factors and laboratory data 1 month after targeted therapy initiation-including inflammatory markers (neutrophil count, neutrophil-to-lymphocyte ratio and C-reactive protein) and lactate dehydrogenase-were reviewed. To identify progression-free survival predictors, multivariate analyses were done. RESULTS: The 1-year progression-free survival rate was 47%. Female gender, Karnofsky performance status <80%, time from diagnosis to systemic treatment <12 months, pretreatment C-reactive protein >3.0 mg/dl and post-treatment neutrophil-to-lymphocyte ratio >3.0 were independent predictors for progression-free survival. In contrast, neither C-reactive protein increase nor neutrophil-to-lymphocyte ratio increase after targeted therapy initiation were independent predictors. Pretreatment lactate dehydrogenase, post-treatment lactate dehydrogenase and lactate dehydrogenase decline were not independent predictors. When all patients were stratified by these independent factors into three groups (0 risk vs. 1 or 2 risks vs. 3 or more risks), there were significant differences in progression-free survival rates between the groups (P < 0.0001). Furthermore, there were also significant differences in overall survival rates between the groups (P < 0.0001). CONCLUSIONS: Integration of post-treatment neutrophil-to-lymphocyte ratio value with pretreatment factors may lead to the establishment of effective predictive model for disease progression in patients with metastatic clear cell renal cell carcinoma who received first-line targeted therapies.
OBJECTIVES: Progression-free survival of first-line targeted therapy greatly influences the survival of patients with metastatic renal cell carcinoma. We evaluated whether post-treatment inflammatory markers and lactate dehydrogenase levels had impacts on progression-free survival prediction in addition to those of conventional predictors. METHODS: Two hundred and fifteen patients whose tumors were clear cell type and in whom first-line targeted therapies could be continued for >1 month were evaluated. Pretreatment clinical factors, pathological factors and laboratory data 1 month after targeted therapy initiation-including inflammatory markers (neutrophil count, neutrophil-to-lymphocyte ratio and C-reactive protein) and lactate dehydrogenase-were reviewed. To identify progression-free survival predictors, multivariate analyses were done. RESULTS: The 1-year progression-free survival rate was 47%. Female gender, Karnofsky performance status <80%, time from diagnosis to systemic treatment <12 months, pretreatment C-reactive protein >3.0 mg/dl and post-treatment neutrophil-to-lymphocyte ratio >3.0 were independent predictors for progression-free survival. In contrast, neither C-reactive protein increase nor neutrophil-to-lymphocyte ratio increase after targeted therapy initiation were independent predictors. Pretreatment lactate dehydrogenase, post-treatment lactate dehydrogenase and lactate dehydrogenase decline were not independent predictors. When all patients were stratified by these independent factors into three groups (0 risk vs. 1 or 2 risks vs. 3 or more risks), there were significant differences in progression-free survival rates between the groups (P < 0.0001). Furthermore, there were also significant differences in overall survival rates between the groups (P < 0.0001). CONCLUSIONS: Integration of post-treatment neutrophil-to-lymphocyte ratio value with pretreatment factors may lead to the establishment of effective predictive model for disease progression in patients with metastatic clear cell renal cell carcinoma who received first-line targeted therapies.
Authors: Florian Janisch; Thomas Klotzbücher; Roland Dahlem; Michael Rink; Phillip Marks; Christina Kienapfel; Christian P Meyer; Hang Yu; Constantin Fühner; Tobias Hillemacher; Keiichiro Mori; Hadi Mostafei; Shahrokh F Shariat; Margit Fisch Journal: World J Urol Date: 2021-03-01 Impact factor: 4.226