Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma
Details
Publication Year 2016-08-10, Volume 46, Issue #11, Page 1291-1297
Journal Title
Internal Medicine Journal
Publication Type
Journal Article
Abstract
BACKGROUND: The role of cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) in the era of targeted therapies is currently undefined. In recent years, neutrophil-to-lymphocyte ratio (NLR) has emerged as a prognostic marker in several cancers including mRCC. In this multi-centre retrospective study, we aim to assess the impact of CN in mRCC and the value of NLR in risk stratification and patient selection. METHODS: Retrospective data from patients with de novo mRCC from 4 large Australian hospitals were collected. Survival analyses were performed using the Kaplan-Meier method and compared using the log-rank test. Multivariate analyses used the Cox proportional hazards method. RESULTS: Our study identified 91 de novo mRCC patients. Patients who underwent CN (n = 46, 51%) were more likely to be younger (59.0y vs. 64.6y, p = 0.019), and to have received systemic therapy (91% vs. 76%, p = 0.043). Median overall survival (mOS) was significantly improved in patients who underwent CN (23.0mo vs. 10.9mo, HR 0.33, 95% CI 0.20-0.55, p < 0.0001). Patients with NLR>/=5 also had inferior mOS (6.2mo vs. 16.7mo, HR 1.94, 95% CI 1.14-3.29, p = 0.014). CN was associated with substantially improved survival in patients with both NLR<5 (mOS 31.1mo vs. 7.0mo; HR 0.41; 95% CI, 0.18-0.64; p = 0.0009) and NLR>/=5 (mOS 10.9mo vs. 2.3mo; HR 0.33; 95% CI, 0.11-0.69; p = 0.009). Significant survival benefits associated with CN were maintained in multivariate analyses (HR 0.39; 95% CI, 0.22-0.70; p = 0.0014). CONCLUSIONS: CN is associated with significantly improved OS in de novo mRCC. The incremental survival benefit associated with CN was seen irrespective of NLR.
Publisher
Wiley
WEHI Research Division(s)
Systems Biology And Personalised Medicine
PubMed ID
27507629
Publisher's Version
https://doi.org/10.1111/imj.13202
Rights Notice
Refer to copyright notice on published article.


Creation Date: 2016-08-19 02:01:10
Last Modified: 2018-07-05 09:07:50
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