Skip to main content
Erschienen in: International Urology and Nephrology 6/2016

05.03.2016 | Urology - Original Paper

Comprehensive analysis and validation of contemporary survival prognosticators in Korean patients with metastatic renal cell carcinoma treated with targeted therapy: prognostic impact of pretreatment neutrophil-to-lymphocyte ratio

verfasst von: Kyo Chul Koo, Kwang Suk Lee, Kang Su Cho, Koon Ho Rha, Sung Joon Hong, Byung Ha Chung

Erschienen in: International Urology and Nephrology | Ausgabe 6/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

In line with the era of targeted therapy (TT), an increasing number of prognosticators are becoming available for patients with metastatic renal cell carcinoma (mRCC). Here, potential prognosticators of cancer-specific survival (CSS) were identified based on the contemporary literature and were comprehensively validated in an independent cohort of patients treated for mRCC.

Methods

Data were collected from 478 patients treated with TT for mRCC between January 1999 and July 2013 at a single institution. The analysis included 25 clinicopathological covariates that included both traditional and contemporary prognosticators. Multivariate Cox regression models were used to quantify the effect of covariates on CSS.

Results

Median survival from the initial diagnosis of metastasis was 24.5 (IQR, 11.5–55.7) months. There were 303 (63.4 %) cancer-specific deaths, yielding a 2-year CSS rate of 62.5 %. Low Karnofsky performance status (KPS), hypercalcemia, neutrophil-to-lymphocyte ratio (NLR), the number of metastatic sites (≥2), and the presence of brain metastases were independent adverse prognosticators of CSS. The C-index of the model was 0.78. Patients with at least one adverse prognosticator demonstrated lower 2-year CSS rates compared to those with no prognosticators (53.9 vs. 70.6 %; log rank p < 0.001).

Conclusions

Together with traditional prognosticators such as KPS, hypercalcemia, and the number and location of metastases, the NLR was an independent predictor of CSS in patients with mRCC treated with TT. Our findings could be useful for guiding clinical decision making including stratification of patients for TT and inclusion in clinical trials.
Literatur
1.
Zurück zum Zitat Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DY, Uzzo RG (2006) The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 175:425–431CrossRefPubMed Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DY, Uzzo RG (2006) The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 175:425–431CrossRefPubMed
2.
3.
Zurück zum Zitat Margulis V, Shariat SF, Rapoport Y, Rink M, Sjoberg DD, Tannir NM et al (2013) Development of accurate models for individualized prediction of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma. Eur Urol 63:947–952CrossRefPubMed Margulis V, Shariat SF, Rapoport Y, Rink M, Sjoberg DD, Tannir NM et al (2013) Development of accurate models for individualized prediction of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma. Eur Urol 63:947–952CrossRefPubMed
4.
Zurück zum Zitat Motzer RJ, Bacik J, Murphy BA, Russo P, Mazumdar M (2002) Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 20:289–296CrossRefPubMed Motzer RJ, Bacik J, Murphy BA, Russo P, Mazumdar M (2002) Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 20:289–296CrossRefPubMed
5.
Zurück zum Zitat Heng DY, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C et al (2009) Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol 27:5794–5799CrossRefPubMed Heng DY, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C et al (2009) Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol 27:5794–5799CrossRefPubMed
6.
Zurück zum Zitat Cetin B, Berk V, Kaplan MA, Afsar B, Tufan G, Ozkan M et al (2013) Is the pretreatment neutrophil to lymphocyte ratio an important prognostic parameter in patients with metastatic renal cell carcinoma? Clin Genitourin Cancer 11:141–148CrossRefPubMed Cetin B, Berk V, Kaplan MA, Afsar B, Tufan G, Ozkan M et al (2013) Is the pretreatment neutrophil to lymphocyte ratio an important prognostic parameter in patients with metastatic renal cell carcinoma? Clin Genitourin Cancer 11:141–148CrossRefPubMed
7.
Zurück zum Zitat Grunwald V, McKay RR, Krajewski KM, Kalanovic D, Lin X, Perkins JJ et al (2015) Depth of remission is a prognostic factor for survival in patients with metastatic renal cell carcinoma. Eur Urol 67:952–958CrossRefPubMedPubMedCentral Grunwald V, McKay RR, Krajewski KM, Kalanovic D, Lin X, Perkins JJ et al (2015) Depth of remission is a prognostic factor for survival in patients with metastatic renal cell carcinoma. Eur Urol 67:952–958CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Kroeger N, Pantuck AJ, Wells JC, Lawrence N, Broom R, Kim JJ et al (2015) Characterizing the impact of lymph node metastases on the survival outcome for metastatic renal cell carcinoma patients treated with targeted therapies. Eur Urol 68:506–515CrossRefPubMed Kroeger N, Pantuck AJ, Wells JC, Lawrence N, Broom R, Kim JJ et al (2015) Characterizing the impact of lymph node metastases on the survival outcome for metastatic renal cell carcinoma patients treated with targeted therapies. Eur Urol 68:506–515CrossRefPubMed
9.
Zurück zum Zitat Tilki D, Hu B, Nguyen HG, Dall’Era MA, Bertini R, Carballido JA et al (2015) Impact of synchronous metastasis distribution on cancer specific survival in renal cell carcinoma after radical nephrectomy with tumor thrombectomy. J Urol 193:436–442CrossRefPubMed Tilki D, Hu B, Nguyen HG, Dall’Era MA, Bertini R, Carballido JA et al (2015) Impact of synchronous metastasis distribution on cancer specific survival in renal cell carcinoma after radical nephrectomy with tumor thrombectomy. J Urol 193:436–442CrossRefPubMed
10.
Zurück zum Zitat Isbarn H, Karakiewicz PI (2009) Predicting cancer-control outcomes in patients with renal cell carcinoma. Curr Opin Urol 19:247–257CrossRefPubMed Isbarn H, Karakiewicz PI (2009) Predicting cancer-control outcomes in patients with renal cell carcinoma. Curr Opin Urol 19:247–257CrossRefPubMed
11.
Zurück zum Zitat Leibovich BC, Cheville JC, Lohse CM, Zincke H, Frank I, Kwon ED et al (2005) A scoring algorithm to predict survival for patients with metastatic clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. J Urol 174:1759–1763CrossRefPubMed Leibovich BC, Cheville JC, Lohse CM, Zincke H, Frank I, Kwon ED et al (2005) A scoring algorithm to predict survival for patients with metastatic clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. J Urol 174:1759–1763CrossRefPubMed
12.
Zurück zum Zitat Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X et al (2012) Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 30:419–425CrossRefPubMed Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X et al (2012) Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 30:419–425CrossRefPubMed
13.
Zurück zum Zitat McKay RR, Kroeger N, Xie W, Lee JL, Knox JJ, Bjarnason GA et al (2014) Impact of bone and liver metastases on patients with renal cell carcinoma treated with targeted therapy. Eur Urol 65:577–584CrossRefPubMed McKay RR, Kroeger N, Xie W, Lee JL, Knox JJ, Bjarnason GA et al (2014) Impact of bone and liver metastases on patients with renal cell carcinoma treated with targeted therapy. Eur Urol 65:577–584CrossRefPubMed
14.
Zurück zum Zitat Han KR, Pantuck AJ, Bui MH, Shvarts O, Freitas DG, Zisman A et al (2003) Number of metastatic sites rather than location dictates overall survival of patients with node-negative metastatic renal cell carcinoma. Urology 61:314–319CrossRefPubMed Han KR, Pantuck AJ, Bui MH, Shvarts O, Freitas DG, Zisman A et al (2003) Number of metastatic sites rather than location dictates overall survival of patients with node-negative metastatic renal cell carcinoma. Urology 61:314–319CrossRefPubMed
15.
Zurück zum Zitat Procopio G, Testa I, Verzoni E, Iacovelli R, Grassi P, Galli G et al (2015) Time from nephrectomy as a prognostic factor in metastatic renal cell carcinoma patients receiving targeted therapies: overall results from a large cohort of patients. Oncology 88:133–138CrossRefPubMed Procopio G, Testa I, Verzoni E, Iacovelli R, Grassi P, Galli G et al (2015) Time from nephrectomy as a prognostic factor in metastatic renal cell carcinoma patients receiving targeted therapies: overall results from a large cohort of patients. Oncology 88:133–138CrossRefPubMed
16.
Zurück zum Zitat Kim HL, Belldegrun AS, Freitas DG, Bui MH, Han KR, Dorey FJ et al (2003) Paraneoplastic signs and symptoms of renal cell carcinoma: implications for prognosis. J Urol 170:1742–1746CrossRefPubMed Kim HL, Belldegrun AS, Freitas DG, Bui MH, Han KR, Dorey FJ et al (2003) Paraneoplastic signs and symptoms of renal cell carcinoma: implications for prognosis. J Urol 170:1742–1746CrossRefPubMed
17.
Zurück zum Zitat Negrier S, Escudier B, Gomez F, Douillard JY, Ravaud A, Chevreau C et al (2002) Prognostic factors of survival and rapid progression in 782 patients with metastatic renal carcinomas treated by cytokines: a report from the Groupe Francais d’Immunotherapie. Ann Oncol 13:1460–1468CrossRefPubMed Negrier S, Escudier B, Gomez F, Douillard JY, Ravaud A, Chevreau C et al (2002) Prognostic factors of survival and rapid progression in 782 patients with metastatic renal carcinomas treated by cytokines: a report from the Groupe Francais d’Immunotherapie. Ann Oncol 13:1460–1468CrossRefPubMed
18.
Zurück zum Zitat Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O et al (2007) Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356:115–124CrossRefPubMed Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O et al (2007) Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356:115–124CrossRefPubMed
19.
Zurück zum Zitat Wronski M, Maor MH, Davis BJ, Sawaya R, Levin VA (1997) External radiation of brain metastases from renal carcinoma: a retrospective study of 119 patients from the M. D. Anderson Cancer Center. Int J Radiat Oncol Biol Phys 37:753–759CrossRefPubMed Wronski M, Maor MH, Davis BJ, Sawaya R, Levin VA (1997) External radiation of brain metastases from renal carcinoma: a retrospective study of 119 patients from the M. D. Anderson Cancer Center. Int J Radiat Oncol Biol Phys 37:753–759CrossRefPubMed
20.
Zurück zum Zitat Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRefPubMed Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRefPubMed
21.
Zurück zum Zitat Mekhail TM, Abou-Jawde RM, Boumerhi G, Malhi S, Wood L, Elson P et al (2005) Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma. J Clin Oncol 23:832–841CrossRefPubMed Mekhail TM, Abou-Jawde RM, Boumerhi G, Malhi S, Wood L, Elson P et al (2005) Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma. J Clin Oncol 23:832–841CrossRefPubMed
22.
Zurück zum Zitat Choueiri TK, Garcia JA, Elson P, Khasawneh M, Usman S, Golshayan AR et al (2007) Clinical factors associated with outcome in patients with metastatic clear-cell renal cell carcinoma treated with vascular endothelial growth factor-targeted therapy. Cancer 110:543–550CrossRefPubMed Choueiri TK, Garcia JA, Elson P, Khasawneh M, Usman S, Golshayan AR et al (2007) Clinical factors associated with outcome in patients with metastatic clear-cell renal cell carcinoma treated with vascular endothelial growth factor-targeted therapy. Cancer 110:543–550CrossRefPubMed
23.
Zurück zum Zitat Motzer RJ, Bukowski RM, Figlin RA, Hutson TE, Michaelson MD, Kim ST et al (2008) Prognostic nomogram for sunitinib in patients with metastatic renal cell carcinoma. Cancer 113:1552–1558CrossRefPubMed Motzer RJ, Bukowski RM, Figlin RA, Hutson TE, Michaelson MD, Kim ST et al (2008) Prognostic nomogram for sunitinib in patients with metastatic renal cell carcinoma. Cancer 113:1552–1558CrossRefPubMed
24.
Zurück zum Zitat Sheehan JP, Sun MH, Kondziolka D, Flickinger J, Lunsford LD (2003) Radiosurgery in patients with renal cell carcinoma metastasis to the brain: long-term outcomes and prognostic factors influencing survival and local tumor control. J Neurosurg 98:342–349CrossRefPubMed Sheehan JP, Sun MH, Kondziolka D, Flickinger J, Lunsford LD (2003) Radiosurgery in patients with renal cell carcinoma metastasis to the brain: long-term outcomes and prognostic factors influencing survival and local tumor control. J Neurosurg 98:342–349CrossRefPubMed
25.
Zurück zum Zitat Flanigan RC, Mickisch G, Sylvester R, Tangen C, Van Poppel H, Crawford ED (2004) Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol 171:1071–1076CrossRefPubMed Flanigan RC, Mickisch G, Sylvester R, Tangen C, Van Poppel H, Crawford ED (2004) Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol 171:1071–1076CrossRefPubMed
Metadaten
Titel
Comprehensive analysis and validation of contemporary survival prognosticators in Korean patients with metastatic renal cell carcinoma treated with targeted therapy: prognostic impact of pretreatment neutrophil-to-lymphocyte ratio
verfasst von
Kyo Chul Koo
Kwang Suk Lee
Kang Su Cho
Koon Ho Rha
Sung Joon Hong
Byung Ha Chung
Publikationsdatum
05.03.2016
Verlag
Springer Netherlands
Erschienen in
International Urology and Nephrology / Ausgabe 6/2016
Print ISSN: 0301-1623
Elektronische ISSN: 1573-2584
DOI
https://doi.org/10.1007/s11255-016-1252-9

Weitere Artikel der Ausgabe 6/2016

International Urology and Nephrology 6/2016 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.