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Change in Neutrophil-to-lymphocyte Ratio in Response to Targeted Therapy for Metastatic Renal Cell Carcinoma as a Prognosticator and Biomarker of Efficacy.

Abstract：

BACKGROUND:Neutrophil-to-lymphocyte ratio (NLR), if elevated, is associated with worse outcomes in several malignancies. OBJECTIVE:Investigation of NLR at baseline and during therapy for metastatic renal cell carcinoma. DESIGN, SETTING, AND PARTICIPANTS:Retrospective analysis of 1199 patients from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC cohort) and 4350 patients from 12 prospective randomized trials (validation cohort). INTERVENTION:Targeted therapies for metastatic renal cell carcinoma. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:NLR was examined at baseline and 6 (± 2) wk later. A landmark analysis at 8 wk was conducted to explore the prognostic value of relative NLR change on overall survival (OS), progression-free survival (PFS), and objective response rate using Cox or logistic regression models, adjusted for variables in IMDC score and NLR values at baseline. RESULTS AND LIMITATIONS:Higher NLR at baseline was associated with shorter OS and PFS (Hazard Ratios [HR] per 1 unit increase in log-transformed NLR = 1.69 [95% confidence interval {CI} = 1.46-1.95] and 1.30 [95% CI = 1.15-1.48], respectively). Compared with no change (decrease < 25% to increase < 25%, reference), increase NLR at Week 6 by 25-50% and > 75% was associated with poor OS (HR=1.55 [95% CI=1.10-2.18] and 2.31 [95% CI=1.64-3.25], respectively), poor PFS (HR=1.46 [95% CI=1.04-2.03], 1.76 [95% CI=1.23-2.52], respectively), and reduced objective response rate (odds ratios = 0.77 [95% CI=0.37-1.63] and 0.24 [95% CI=0.08-0.72], respectively). By contrast, a decrease of 25-50% was associated with improved outcomes. Findings were confirmed in the validation cohort. The study is limited by its retrospective design. CONCLUSIONS:Compared with no change, early decline of NLR is associated with favorable outcomes, whereas an increase is associated with worse outcomes. PATIENT SUMMARY:We found that the proportion of immune cells in the blood is of prognostic value, namely that a decrease of the proportion of neutrophils-to-lymphocytes is associated with more favorable outcomes while an increase had the opposite effect.

journal_name

Eur Urol

journal_title

European urology

authors

Templeton AJ,Knox JJ,Lin X,Simantov R,Xie W,Lawrence N,Broom R,Fay AP,Rini B,Donskov F,Bjarnason GA,Smoragiewicz M,Kollmannsberger C,Kanesvaran R,Alimohamed N,Hermanns T,Wells JC,Amir E,Choueiri TK,Heng DY

doi

10.1016/j.eururo.2016.02.033

subject

Has Abstract

pub_date

2016-08-01 00:00:00

pages

358-64

issue

eissn

0302-2838

issn

1873-7560

pii

S0302-2838(16)00211-6

journal_volume

pub_type

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Change in Neutrophil-to-lymphocyte Ratio in Response to Targeted Therapy for Metastatic Renal Cell Carcinoma as a Prognosticator and Biomarker of Efficacy.