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Gambale E, Maruzzo M, Messina C, De Gennaro Aquino I, Vascotto IA, Rossi V, Bimbatti D, Cavasin N, Messina M, Mennitto A, Rebuzzi SE, Nasso C, Mercinelli C, Maiorano BA, Fanelli M, Sorarù M, Scolari F, Mela MM, Galli L, Salfi A, Rizzo M, Puglisi S, Orlando V, Fornarini G, Rametta A, Giannatempo P, Cerbone L, Doni L, Roviello G, Pillozzi S, Antonuzzo L. Neutrophil-to-Eosinophil Ratio Predicts the Efficacy of Avelumab in Patients With Advanced Urothelial Carcinoma Enrolled in the MALVA Study (Meet-URO 25). Clin Genitourin Cancer 2024; 22:102099. [PMID: 38776583 DOI: 10.1016/j.clgc.2024.102099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Neutrophil-to-eosinophil ratio (NER) has been described to be associated with outcomes to immune checkpoint inhibitors (ICI) in several tumor types, but less is known about its role of in the response to avelumab in advanced urothelial cancer (aUC). Thus, we reported outcomes by NER of aUC patients treated with avelumab as maintenance after initial response to platinum-based chemotherapy and enrolled in the Maintenance with AVeLumAb ([MALVA] in advanced urothelial neoplasms in response to first-line chemotherapy: an observational retrospective study) study (Meet-URO 25). PATIENTS AND METHODS Median NER at baseline and after 3 cycles of avelumab were calculated. Progression-free survival (PFS) and overall survival (OS) by NER were reported. RESULTS At the cutoff date (April 15, 2023), a total of 109 patients were included. The median NER was 28.05 at baseline and 24.46 after 3 cycles of avelumab, respectively. Median PFS was not reached for patients with baseline NER less than the median ( CONCLUSION
Affiliation(s)
- Elisabetta Gambale
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Careggi University Hospital, Clinical Oncology, Florence, Italy
| | - Marco Maruzzo
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy
| | - Carlo Messina
- Ospedale Arnas Civico, Clinical Oncology, Palermo, Italy
| | - Irene De Gennaro Aquino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Careggi University Hospital, Clinical Oncology, Florence, Italy
| | - Ismaela Anna Vascotto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Careggi University Hospital, Clinical Oncology, Florence, Italy
| | - Virginia Rossi
- Careggi University Hospital, Clinical Oncology, Florence, Italy
| | - Davide Bimbatti
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy
| | - Nicolò Cavasin
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy
| | - Marco Messina
- Ospedale Arnas Civico, Clinical Oncology, Palermo, Italy
| | - Alessia Mennitto
- University Hospital Maggiore della Carità, Division of Oncology, Novara, Italy
| | - Sara Elena Rebuzzi
- Ospedale San Paolo, Medical Oncology Unit, Savona, Italy; Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genoa, Genoa, Italy
| | - Cecilia Nasso
- Medical Oncology, Ospedale Santa Corona, 17027 Pietra Ligure, Italy
| | - Chiara Mercinelli
- Azienda Ospedaliero-Universitaria Pisana, Medical Oncology Unit 2, Pisa, Italy; Department of Medical Oncology, IRRCS San Raffaele Hospital, Milan, Italy
| | - Brigida Anna Maiorano
- Department of Medical Oncology, IRRCS San Raffaele Hospital, Milan, Italy; Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Martina Fanelli
- University Hospital of Udine, Department of Oncology, Udine, Italy
| | - Mariella Sorarù
- Ospedale di Camposampiero, U.O. Oncologia, Camposampiero, Italy
| | - Federico Scolari
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | | | - Luca Galli
- Azienda Ospedaliero-Universitaria Pisana, Medical Oncology Unit 2, Pisa, Italy
| | - Alessia Salfi
- Azienda Ospedaliero-Universitaria Pisana, Medical Oncology Unit 2, Pisa, Italy
| | - Mimma Rizzo
- Oncologia Medica Universitaria Azienda Ospedaliera Universitaria Consorziale Policlinico di Bari piazza Giulio Cesare, 11, 70124 Bari
| | | | | | | | - Alessandro Rametta
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, Milan, Italy
| | - Patrizia Giannatempo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, Milan, Italy
| | - Linda Cerbone
- Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - Laura Doni
- Careggi University Hospital, Clinical Oncology, Florence, Italy
| | - Giandomenico Roviello
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy
| | - Serena Pillozzi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Careggi University Hospital, Clinical Oncology, Florence, Italy
| | - Lorenzo Antonuzzo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Careggi University Hospital, Clinical Oncology, Florence, Italy
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Zhuang TZ, Ravindranathan D, Liu Y, Martini DJ, Brown JT, Nazha B, Russler G, Yantorni LB, Caulfield S, Carthon BC, Kucuk O, Master VA, Bilen MA. Baseline Neutrophil-to-Eosinophil Ratio Is Associated with Outcomes in Metastatic Renal Cell Carcinoma Treated with Immune Checkpoint Inhibitors. Oncologist 2023; 28:239-245. [PMID: 36427017 PMCID: PMC10020802 DOI: 10.1093/oncolo/oyac236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/15/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Biomarkers have the potential to guide treatment selection and clinical care in metastatic renal cell carcinoma (mRCC) in an expanding treatment landscape. We report baseline neutrophil-to-eosinophil ratios (NER) in patients with mRCC treated with immune checkpoint inhibitors (CPIs) and their association with clinical outcomes. METHODS We conducted a retrospective review of patients with mRCC treated with CPIs at Winship Cancer Institute from 2015 to 2020 in the United States of America (USA). Demographics, disease characteristics, and laboratory data, including complete blood counts (CBC) were described at the initiation of CPIs. Clinical outcomes were measured as overall survival (OS), progression-free survival (PFS), and clinical benefit (CB) associated with baseline lab values. RESULTS A total of 184 patients were included with a median follow-up time of 25.4 months. Patients with baseline NER were categorized into high or low subgroups; high group was defined as NER >49.2 and low group was defined as NER <49.2 with 25% of patients in the high NER group. Univariate analyses (UVA) and multivariable analyses (MVA) identified decreased overall survival (OS) associated with elevated NER. In MVA, patients with a high baseline NER group had a hazard ratio (HR) of 1.68 (95%CI, 1.01-2.82, P = .048) for OS; however, there was no significant difference between groups for PFS. Clinical benefit was seen in 47.3% of patients with low baseline NER and 40% with high NER. CONCLUSIONS We conclude that elevated baseline NER may be associated with worse clinical outcomes in mRCC. Although results require further validation, NER is a feasible biomarker in patients with CPI-treated mRCC.
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Affiliation(s)
- Tony Z Zhuang
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Deepak Ravindranathan
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, GA, USA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Dylan J Martini
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jacqueline T Brown
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Bassel Nazha
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, GA, USA
| | - Greta Russler
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren B Yantorni
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah Caulfield
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Bradley C Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, GA, USA
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, GA, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Sellers CM, Uhlig J, Ludwig JM, Pollak JS, Taddei TH, Stein SM, Lim JK, Kim HS. The effect of chronic viral hepatitis on prognostic value of inflammatory biomarkers in hepatocellular carcinoma. Cancer Med 2021; 10:5395-5404. [PMID: 34318618 PMCID: PMC8366096 DOI: 10.1002/cam4.3573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/09/2020] [Accepted: 10/07/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Inflammation and the immune system significantly impact the development, progression, and treatment response of hepatocellular carcinoma (HCC). This retrospective study investigated the neutrophil-to-lymphocyte ratio (NLR) as a prognostic biomarker in Western patients with HCC in the setting of chronic viral hepatitis. METHODS Patients diagnosed with HCC from 2005 to 2016 were selected from a tertiary care institution. NLR was calculated within 30 days prior to treatment and dichotomized at the median. Kaplan-Meier overall survival (OS) curves and Cox hazard proportional models were utilized. Tumor and liver reserve parameters were included in multivariable analyses (MVA). RESULTS A total of 581 patients met inclusion criteria (median age 61.0 yr; 78.3% male; 66.3% Caucasian) with median OS = 34.9 mo. 371 patients (63.9%) had viral hepatitis, of which 350 had hepatitis C (94.3%). The low-NLR group ( CONCLUSIONS Lower baseline NLR was associated with increased overall survival in HCC. Viral hepatitis serves as an effect modifier of NLR, attenuating its prognostic relevance in this hepatitis C-predominant population.
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Affiliation(s)
- Cortlandt M. Sellers
- Section of Interventional RadiologyDepartment of Radiology and Biomedical ImagingYale University School of MedicineNew HavenCTUSA
- Department of RadiologyBaylor College of MedicineHoustonTXUSA
| | - Johannes Uhlig
- Section of Interventional RadiologyDepartment of Radiology and Biomedical ImagingYale University School of MedicineNew HavenCTUSA
- Department for Diagnostic and Interventional RadiologyUniversity Medical Center GoettingenGoettingenGermany
| | - Johannes M. Ludwig
- Section of Interventional RadiologyDepartment of Radiology and Biomedical ImagingYale University School of MedicineNew HavenCTUSA
- Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital EssenUniversity of Duisburg‐EssenEssenGermany
| | - Jeffrey S. Pollak
- Section of Interventional RadiologyDepartment of Radiology and Biomedical ImagingYale University School of MedicineNew HavenCTUSA
| | - Tamar H. Taddei
- Section of Digestive DiseasesDepartment of Internal MedicineYale University School of MedicineNew HavenCTUSA
| | - Stacey M. Stein
- Section of Medical OncologyDepartment of Internal MedicineYale University School of MedicineNew HavenCTUSA
- Yale Cancer CenterYale University School of MedicineNew HavenCTUSA
| | - Joseph K. Lim
- Section of Digestive DiseasesDepartment of Internal MedicineYale University School of MedicineNew HavenCTUSA
| | - Hyun S. Kim
- Section of Interventional RadiologyDepartment of Radiology and Biomedical ImagingYale University School of MedicineNew HavenCTUSA
- Section of Medical OncologyDepartment of Internal MedicineYale University School of MedicineNew HavenCTUSA
- Yale Cancer CenterYale University School of MedicineNew HavenCTUSA
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Liu H, Sun S, Wang G, Lu M, Zhang X, Wei X, Gao X, Huang C, Li Z, Zheng J, Zhang Q. Tyrosine Kinase Inhibitor Cabozantinib Inhibits Murine Renal Cancer by Activating Innate and Adaptive Immunity. Front Oncol 2021; 11:663517. [PMID: 33954115 PMCID: PMC8089383 DOI: 10.3389/fonc.2021.663517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/29/2021] [Indexed: 12/20/2022] Open
Abstract
Background Advanced renal cell carcinoma (RCC) has a very dismal prognosis. Cabozantinib, a tyrosine kinase inhibitor, has been approved for the treatment of advanced RCC. However, the impact of cabozantinib on the immune microenvironment of RCC remains poorly understood. Methods Kaplan-Meier survival curves were constructed to examine the correlation between intratumor infiltration of neutrophils and patient prognosis in RCC. Infiltration and effector function of neutrophils and T cells in response to cabozantinib treatment were investigated in a murine RCC model. Results A retrospective study of 307 RCC patients indicated that neutrophils were recruited into tumor tissues, and increased neutrophil infiltration was associated with improved clinical outcomes. In a murine model of RCC, cabozantinib treatment significantly increased both intratumor infiltration and anti-tumor function of neutrophils and T cells. Mechanistically, we found that cabozantinib treatment induced expression of neutrophil-related chemokines (CCL11 and CXCL12) and T cell-related chemokines (CCL8 and CX3CL1) in the tumor microenvironment. Furthermore, depletion of neutrophils and CD8+ T cells compromised the therapeutic efficacy of cabozantinib. Importantly, cabozantinib treatment induced long-term anti-tumor T cell response. Conclusions Our study revealed novel mechanisms of the therapeutic effects of cabozantinib on RCC by activating both neutrophil-mediated innate immunity and T cell-mediated adaptive immunity. These findings are of great significance for guiding the clinical use of cabozantinib and provide a good candidate for future combination therapy with T-cell therapies or other immunotherapies.
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Affiliation(s)
- Hongyan Liu
- Cancer Institute, Xuzhou Medical University, Xuzhou, China.,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Shishuo Sun
- Cancer Institute, Xuzhou Medical University, Xuzhou, China.,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Gang Wang
- Cancer Institute, Xuzhou Medical University, Xuzhou, China.,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Mengmeng Lu
- Cancer Institute, Xuzhou Medical University, Xuzhou, China.,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xiaokang Zhang
- Cancer Institute, Xuzhou Medical University, Xuzhou, China.,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xiaohuan Wei
- Cancer Institute, Xuzhou Medical University, Xuzhou, China.,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xiaoge Gao
- Cancer Institute, Xuzhou Medical University, Xuzhou, China.,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chao Huang
- Cancer Institute, Xuzhou Medical University, Xuzhou, China.,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhen Li
- Cancer Institute, Xuzhou Medical University, Xuzhou, China.,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Junnian Zheng
- Cancer Institute, Xuzhou Medical University, Xuzhou, China.,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Qing Zhang
- Cancer Institute, Xuzhou Medical University, Xuzhou, China.,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Inflammatory Markers in Cancer Immunotherapy. BIOLOGY 2021; 10:biology10040325. [PMID: 33924623 PMCID: PMC8069970 DOI: 10.3390/biology10040325] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/01/2021] [Accepted: 04/10/2021] [Indexed: 12/12/2022]
Abstract
Simple Summary Inflammation has been recognized to be linked to tumor development. Several markers of inflammation can be detected via blood such as variety of blood cells, which can be readily and easily obtained. These markers have been studied as ways to predict and prognosticate tumor response to chemotherapy. With the development of immunotherapy, namely immune checkpoint inhibitors (ICIs) such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein 1 (PD-1), and programmed death ligand 1 (PDL-1) PDL-1 inhibitors, several markers have also been studied in assessing tumor response. In this review, we will discuss the various inflammatory markers that have been studied in several tumors treated with ICIs. Abstract Chronic inflammation is considered a major risk factor for cancer formation. Inflammation within
the tumor environment plays a role in its response to therapy, growth, and prognosis. Cancer associated inflammation is known to occur in the tumor microenvironment and in the systemic circulation, and is correlated with disease progression and prognosis in many cancers. Blood cells such as neutrophils, lymphocytes, platelets, and circulating proteins such as C-reactive protein, and interleukins, such as IL-6, have been associated with inflammatory responses, which contribute to tumorigenesis. Cancer has found ways to evade the immune response; a pathway that can attenuate the innate immune response is via blocking immune checkpoints. Development of monoclonal antibodies against inhibitory immune checkpoints such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1) have given rise to immunotherapy, which has shown remarkable responses in anti-tumor activity resulting in several U.S. Federal and Drug Administration (FDA)-approved checkpoint inhibitors. Various inflammatory markers and their prognostic and predictive implications in malignancies treated with immunotherapy will be discussed in this review.
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Marchioni M, Kriegmair M, Heck M, Amiel T, Porpiglia F, Ceccucci E, Campi R, Minervini A, Mari A, Van Bruwaene S, Linares E, Hevia V, Musquera M, D'Anna M, Derweesh I, Bradshaw A, Autorino R, Guruli G, Veccia A, Roussel E, Albersen M, Pavan N, Claps F, Antonelli A, Palumbo C, Klatte T, Erdem S, Mir MC. Development of a Novel Risk Score to Select the Optimal Candidate for Cytoreductive Nephrectomy Among Patients with Metastatic Renal Cell Carcinoma. Results from a Multi-institutional Registry (REMARCC). Eur Urol Oncol 2020; 4:256-263. [PMID: 33384274 DOI: 10.1016/j.euo.2020.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/17/2020] [Accepted: 12/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Selection of patients for upfront cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) has to be improved. OBJECTIVE To evaluate a new scoring system for the prediction of overall mortality (OM) in mRCC patients undergoing CN. DESIGN, SETTING, AND PARTICIPANTS We identified a total of 519 patients with synchronous mRCC undergoing CN between 2005 and 2019 from a multi-institutional registry (Registry for Metastatic RCC [REMARCC]). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cox proportional hazard regression was used to test the main predictors of OM. Restricted mean survival time was estimated as a measure of the average overall survival time up to 36 mo of follow-up. The concordance index (C-index) was used to determine the model's discrimination. Decision curve analyses were used to compare the net benefit from the REMARCC model with International mRCC Database Consortium (IMDC) or Memorial Sloan Kettering Cancer Center (MSKCC) risk scores. RESULTS AND LIMITATIONS The median follow-up period was 18 mo (interquartile range: 5.9-39.7). Our models showed lower mortality rates in obese patients (p = 0.007). Higher OM rates were recorded in those with bone (p = 0.010), liver (p = 0.002), and lung metastases (p < 0.001). Those with poor performance status (<80%) and those with more than three metastases had also higher OM rates (p = 0.026 and 0.040, respectively). The C-index of the REMARCC model was higher than that of the MSKCC and IMDC models (66.4% vs 60.4% vs 60.3%). After stratification, 113 (22.0%) patients were classified to have a favorable (no risk factors), 202 (39.5%) an intermediate (one or two risk factors), and 197 (38.5%) a poor (more than two risk factors) prognosis. Moreover, 72 (17.2%) and 51 (13.9%) patients classified as having an intermediate and a poor prognosis according to MSKCC and IMDC categories, respectively, would be reclassified as having a good prognosis according to the REMARCC score. CONCLUSIONS Our findings confirm the relevance of tumor and patient features for the risk stratification of mRCC patients and clinical decision-making regarding CN. Further prospective external validations are required for the scoring system proposed herein. PATIENT SUMMARY Current stratification systems for selecting patients for kidney removal when metastatic disease is shown are controversial. We suggest a system that includes tumor and patient features besides the systems already in use, which are based on blood tests.
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Affiliation(s)
- Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy; Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | | | - Mathias Heck
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Thomas Amiel
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Francesco Porpiglia
- Department of Urology, School of Medicine, University of Turin-San Luigi Gonzaga Hospital, Turin, Italy
| | - Enrico Ceccucci
- Department of Urology, School of Medicine, University of Turin-San Luigi Gonzaga Hospital, Turin, Italy
| | - Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | | | | | - Vital Hevia
- Department of Urology, Hospital Ramon y Cajal, Madrid, Spain
| | | | | | - Ithaar Derweesh
- Department of Urology, UC San Diego Moores Cancer Center, University of California San Diego School of Medicine, Louisiana Jolla, CA, USA
| | - Aaron Bradshaw
- Department of Urology, UC San Diego Moores Cancer Center, University of California San Diego School of Medicine, Louisiana Jolla, CA, USA
| | | | - Georgi Guruli
- Division of Urology, VCU Medical Center, Richmond, VA, USA
| | | | - Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Nicola Pavan
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Francesco Claps
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, AOUI Verona Hospital, Verona, Italy
| | - Carlotta Palumbo
- Department of Urology, University of Verona, AOUI Verona Hospital, Verona, Italy
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, University Hospitals Dorset, Bournemouth, UK
| | - Selcuk Erdem
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Maria Carmen Mir
- Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain.
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Miron B, Xu D, Zibelman M. Biomarker Development for Metastatic Renal Cell Carcinoma: Omics, Antigens, T-cells, and Beyond. J Pers Med 2020; 10:E225. [PMID: 33202724 PMCID: PMC7712808 DOI: 10.3390/jpm10040225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 12/30/2022] Open
Abstract
The treatment of metastatic renal cell carcinoma has evolved quickly over the last few years from a disease managed primarily with sequential oral tyrosine kinase inhibitors (TKIs) targeting the vascular endothelial growth factor (VEGF) pathway, to now with a combination of therapies incorporating immune checkpoint blockade (ICB). Patient outcomes have improved with these innovations, however, controversy persists regarding optimal sequence and patient selection amongst the available combinations. Ideally, predictive biomarkers would aid in guiding treatment decisions and personalizing care. However, clinically-actionable biomarkers have remained elusive. We aim to review the available evidence regarding biomarkers for both TKIs and ICB and will present where the field may be headed in the years to come.
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Affiliation(s)
| | | | - Matthew Zibelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (B.M.); (D.X.)
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8
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Carlisle JW, Jansen CS, Bilen MA, Kissick H. Considerations for cancer immunotherapy biomarker research during COVID-19. Endocr Relat Cancer 2020; 27:C1-C8. [PMID: 32508308 PMCID: PMC7385701 DOI: 10.1530/erc-20-0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Jennifer W Carlisle
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Caroline S Jansen
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mehmet Asim Bilen
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Haydn Kissick
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, USA
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9
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Nunno VD, Mollica V, Gatto L, Santoni M, Cosmai L, Porta C, Massari F. Prognostic impact of neutrophil-to-lymphocyte ratio in renal cell carcinoma: a systematic review and meta-analysis. Immunotherapy 2020; 11:631-643. [PMID: 30943858 DOI: 10.2217/imt-2018-0175] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIM Estimate prognosis and clinical outcome of patients with localized or metastatic renal cell carcinoma (RCC) is an important issue which drive our medical decisions. METHODS We carried out a meta-analysis of available clinical studies exploring neutrophil-to-lymphocyte ratio (NLR) in RCC in order to evaluate if this ratio could be correlated to overall survival (OS) and progression-free survival (PFS) of patients with localized/metastatic RCC. RESULTS In overall population higher NLR resulted in worst OS and PFS (OS pooled hazard ratio of 1.80; 95% CI: 1.61-2.00; I2 45%; PFS pooled hazard ratio of 1.69; 95% CI: 1.42-2.01; I2 81%), this negative correlation was also confirmed in both metastatic and nonmetastatic patients. CONCLUSION The NLR ratio is a variable correlated to prognosis in RCC patients.
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Affiliation(s)
| | - Veronica Mollica
- Division of Oncology, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Lidia Gatto
- Division of Oncology, S.Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Laura Cosmai
- Onco-Nephrology Outpatient Clinic, Division of Nephrology & Dialysis, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Camillo Porta
- Department of Internal Medicine, University of Pavia & Division of Traslational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
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Preoperative Neutrophil-to-Lymphocyte Ratio Was a Predictor of Overall Survival in Small Renal Cell Carcinoma: An Analysis of 384 Consecutive Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8051210. [PMID: 32219142 PMCID: PMC7079219 DOI: 10.1155/2020/8051210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/07/2019] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
Abstract
Objective The aim of this study was to investigate the prognostic significance of the preoperative neutrophil-to-lymphocyte ratio (NLR) in small renal cell carcinoma (sRCC, ≤4 cm). Methods This study was approved by the review board (NO.XYFY2019-KL032-01). Between 2007 and 2016, a total of 384 consecutive patients who underwent curative surgery for sRCC at our institution were evaluated. Patients were divided into high NLR and low NLR groups by plotting the NLR receiver operating characteristic curve. The Kaplan–Meier method was utilized to graphically display survivor functions. Univariate and multivariate Cox proportional hazards regression analysis addressed time to overall survival (OS) and cancer-specific survival (CSS). Results Of the 384 patients, 264 (68.8%) were males and 120 (31.2%) were females. Median follow-up time after surgical resection was 54 months. One hundred and eighty-seven (48.7%) patients had a high NLR (≥1.97), and the remaining 197 (51.3%) had a low NLR (<1.97). Patients with high NLR were more likely to be aged compared with patients with low NLR (P=0.028). High NLR was associated with decreased OS and CSS compared with low NLR (P=0.028). High NLR was associated with decreased OS and CSS compared with low NLR (P=0.028). High NLR was associated with decreased OS and CSS compared with low NLR (P=0.028). High NLR was associated with decreased OS and CSS compared with low NLR ( Conclusions Elevated preoperative NLR is an independent adverse prognostic factor for OS after surgery with curative intent for sRCC.
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11
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Brighi N, Farolfi A, Conteduca V, Gurioli G, Gargiulo S, Gallà V, Schepisi G, Lolli C, Casadei C, De Giorgi U. The Interplay between Inflammation, Anti-Angiogenic Agents, and Immune Checkpoint Inhibitors: Perspectives for Renal Cell Cancer Treatment. Cancers (Basel) 2019; 11:E1935. [PMID: 31817109 PMCID: PMC6966461 DOI: 10.3390/cancers11121935] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/30/2019] [Accepted: 12/01/2019] [Indexed: 12/12/2022] Open
Abstract
Treatment options for metastatic renal cell carcinoma (RCC) have been expanding in the last years, from the consolidation of several anti-angiogenic agents to the approval of immune checkpoint inhibitors (ICIs). The rationale for the use of immunomodulating agents derived from the observation that RCC usually shows a diffuse immune-cell infiltrate. ICIs target Cytotoxic T Lymphocytes Antigen 4 (CTLA-4), programmed death 1 (PD-1), or its ligand (PD-L1), showing promising therapeutic efficacy in RCC. PD-L1 expression is associated with poor prognosis; however, its predictive role remains debated. In fact, ICIs may be a valid option even for PD-L1 negative patients. The establishment of valid predictors of treatment response to available therapeutic options is advocated to identify those patients who could benefit from these agents. Both local and systemic inflammation contribute to tumorigenesis and development of cancer. The interplay of tumor-immune status and of cancer-related systemic inflammation is pivotal for ICI-treatment outcome, but there is an unmet need for a more precise characterization. To date, little is known on the role of inflammation markers on PD-1 blockade in RCC. In this paper, we review the current knowledge on the interplay between inflammation markers, PD-1 axis, and anti-angiogenic agents in RCC, focusing on biological rationale, implications for treatment, and possible future perspectives.
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Affiliation(s)
- Nicole Brighi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Alberto Farolfi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Vincenza Conteduca
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Giorgia Gurioli
- Bioscience Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (G.G.); (S.G.)
| | - Stefania Gargiulo
- Bioscience Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (G.G.); (S.G.)
| | - Valentina Gallà
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Giuseppe Schepisi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Cristian Lolli
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Chiara Casadei
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Ugo De Giorgi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
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Silagy AW, Flynn J, Mano R, Blum KA, Marcon J, DiNatale RG, Sanchez A, Carlo MI, Motzer RJ, Coleman JA, Russo P, Ostrovnaya I, Chen YB, Hakimi AA. Clinicopathologic features associated with survival after cytoreductive nephrectomy for nonclear cell renal cell carcinoma. Urol Oncol 2019; 37:811.e9-811.e16. [PMID: 31521530 DOI: 10.1016/j.urolonc.2019.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/25/2019] [Accepted: 07/16/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To report the overall survival (OS) outcomes of patients with nonclear cell renal cell carcinoma (nccRCC) treated at our institution with a cytoreductive nephrectomy (CN) and better understand the clinical and pathological characteristics of the patients that respond best. MATERIAL AND METHODS We queried our prospectively maintained database for patients who underwent CN for nccRCC between 1989 and 2018. Histology was reviewed by an expert genitourinary pathologist, and nccRCC tumors were subdivided into papillary, unclassified, chromophobe, and other histology. Baseline clinicopathology, treatments, and survival outcomes were recorded. Preoperative hematological parameters including the neutrophil-to-lymphocyte ratio (NLR) were analyzed. Significant univariate predictors of OS were tested in a multivariate model. RESULTS There were 100 nccRCC patients treated with CN. Median age was 61 years (IQR: 48-69) and 65% were male. There were 79 patient deaths with a median OS of 13.7 months (10.8-27.2). Estimated 2- and 5-year survival was 40.1% and 12.2%, respectively. Median follow-up of survivors was 13 months (IQR: 3-30). On multivariate analysis, increasing NLR (hazard ratio [HR] 1.27; 95% confidence interval [CI] 1.14-1.40, P < 0.001) and sarcomatoid features (HR 2.18; 95% CI 1.19-3.97, P = 0.014) conferred worse OS and the presence of papillary features were a favorable prognostic feature (HR 0.37; 95% CI 0.21-0.65, P < 0.001). CONCLUSIONS OS outcomes in patients with nccRCC who underwent a CN are consistently modest throughout the study period. Patients with papillary features and a lower preoperative NLR may be better candidates for a CN.
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Affiliation(s)
- Andrew W Silagy
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - Jessica Flynn
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roy Mano
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kyle A Blum
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Julian Marcon
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Urology, University Hospital of Munich, Munich, Germany
| | - Renzo G DiNatale
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alejandro Sanchez
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria I Carlo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Paul Russo
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Irina Ostrovnaya
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yingbei B Chen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ari A Hakimi
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY.
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Sellers CM, Uhlig J, Ludwig JM, Stein SM, Kim HS. Inflammatory markers in intrahepatic cholangiocarcinoma: Effects of advanced liver disease. Cancer Med 2019; 8:5916-5929. [PMID: 31429524 PMCID: PMC6792510 DOI: 10.1002/cam4.2373] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To investigate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) as prognostic biomarkers in intrahepatic cholangiocarcinoma (ICC) with a focus on viral hepatitis and liver status. METHODS In this retrospective cohort study, patients from the institutional cancer registry with ICC from 2005 to 2016 were stratified by treatment group. Baseline inflammatory markers were dichotomized at the median. Overall survival (OS) was assessed via Kaplan-Meier curves and Cox proportional hazard models. Multiple patient, liver, and tumor factors were included in the multivariable analysis (MVA). RESULTS About 131 patients (median age 65 years, 52% male, 76% Caucasian) had a median OS of 13.0 months. Resection/interventional oncology with/without systemic therapy had improved survival vs systemic therapy alone in Child-Pugh A patients (P < 0.01). In Child-Pugh B/C patients, this survival difference became nonsignificant (P = 0.22). Increased NLR and SII were associated with decreased survival (P < 0.01), while dichotomized PLR was not (P = 0.3). On MVA, increased NLR remained an independent prognostic factor (HR 1.6, P < 0.05). In Child-Pugh class A (n = 94), low-NLR had higher OS vs high-NLR (25.4 vs 12.2 months, P < 0.01). In Child-Pugh class B/C (n = 28), NLR did not have a significant effect on median OS (low- vs high-NLR: 6.7 vs 2.9 months, P = 0.2). Child-Pugh class acted as an effect modifier on MVA for NLR (P = 0.0124). CONCLUSIONS The NLR has a stronger impact as a prognostic marker in ICC over the PLR and SII. This survival effect is decreased in advanced liver disease.
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Affiliation(s)
- Cortlandt M Sellers
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Johannes Uhlig
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.,Department for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Johannes M Ludwig
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.,Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stacey M Stein
- Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Hyun S Kim
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.,Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
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14
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Individualised Indications for Cytoreductive Nephrectomy: Which Criteria Define the Optimal Candidates? Eur Urol Oncol 2019; 2:365-378. [DOI: 10.1016/j.euo.2019.04.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/08/2019] [Accepted: 04/16/2019] [Indexed: 12/12/2022]
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15
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Mason RJ, Wood L, Kapoor A, Basappa N, Bjarnason G, Boorjian SA, Breau RH, Cagiannos I, Jewett MA, Karakiewicz PI, Kassouf W, Kollmannsberger C, Lalani AKA, Lattouf JB, Lavallée LT, Pautler S, Power N, Richard P, So A, Tanguay S, Rendon RA. Kidney Cancer Research Network of Canada (KCRNC) consensus statement on the role of cytoreductive nephrectomy for patients with metastatic renal cell carcinoma. Can Urol Assoc J 2019; 13:166-174. [PMID: 31199235 PMCID: PMC6570591 DOI: 10.5489/cuaj.5786] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ross J. Mason
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Lori Wood
- Division of Medical Oncology, Dalhousie University, Halifax, NS, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Naveen Basappa
- Division of Medical Oncology, University of Alberta, Edmonton, AB, Canada
| | - George Bjarnason
- Division of Medical Oncology, University of Toronto, Toronto, ON, Canada
| | | | - Rodney H. Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Wassim Kassouf
- Division of Urology, McGill University, Montreal, QC, Canada
| | | | | | | | | | | | - Nicholas Power
- Division of Urology, Western University, London, ON, Canada
| | - Patrick Richard
- Division of Urology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Alan So
- Department of Urologic Sciences, University of British Colombia, Vancouver, BC, Canada
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC, Canada
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16
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Zhu Y, Zhao YR, Yang XF, Wei MT, Niu YJ, Chang JW, Wang AX, Liang X. Postoperative prognostic model for patients with clear cell renal cell carcinoma in a Chinese population. Int J Urol 2019; 26:624-629. [PMID: 30861595 DOI: 10.1111/iju.13936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/06/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To develop a predictive model for the oncological outcomes of clear cell renal cell carcinoma in a Chinese population. METHODS A retrospective study of 1108 patients with clear cell renal cell carcinoma who underwent nephrectomy or partial nephrectomy between January 2006 and December 2013 was carried out. Recurrence-free survival was calculated using Kaplan-Meier analysis. Differences between the groups were compared using the log-rank test. Cox proportional hazard regression was used to test associations between features and outcomes. The discriminative ability of the models was validated using Harrell's concordance index and bootstrapping. RESULTS Overall, 942 patients who met the inclusion criteria had been followed. The median follow-up period was 72 months (range 1-143 months). Multivariate analysis showed that age, Eastern Cooperative Oncology Group performance status, preoperative platelet count, neutrophil-to-lymphocyte ratio, tumor size, 2010 tumor stage (pT3 and pT4) and Fuhrman nuclear grade were independent risk factors affecting recurrence-free survival in clear cell renal cell carcinoma patients (P < 0.05). These factors were assigned to develop a new model. The patients were divided into three groups based on the risk of recurrence. The difference among the prognoses of patients in the three groups was statistically significant (P < 0.05). The concordance index for our new model and that for Leibovich's 2018 model were 0.791 and 0.750, respectively. CONCLUSIONS In the present study, the new model has a higher concordance index than does Leibovich's 2018 model of clear cell renal cell carcinoma in the Asian population, with no added pain for patients. This new model might be an appropriate risk stratification tool for clinical work.
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Affiliation(s)
- Yan Zhu
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Yao-Rui Zhao
- Department of Urology, Characteristic Medical Center of People's Armed Police, Tianjin, China.,Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xian-Fa Yang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Mao-Ti Wei
- Department of Epidemiology, Logistics University of Chinese People's Armed Police Force, Tianjin, China
| | - Yuan-Jie Niu
- Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ji-Wu Chang
- Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ai-Xiang Wang
- Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xuan Liang
- School of Public Health, Tianjin Medical University, Tianjin, China
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Çalışkan S. Elevated neutrophil to lymphocyte and platelet to lymphocyte ratios predict high grade and advanced stage renal cell carcinoma. Int J Biol Markers 2019; 34:15-19. [PMID: 30852956 DOI: 10.1177/1724600818817557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Renal cell carcinoma is the most common malignancy of the kidney, which accounts 85% of all renal tumors. In recent years, the incidence of renal cell carcinoma was increased due to the widespread use of imaging techniques. The aim of this study is to investigate the clinical significance of pretreatment neutrophil to lymphocyte and platelet to lymphocyte ratios in patients with renal cell carcinomas. METHODS The patients who underwent nephrectomy for renal tumor between 2010 and 2018 in two centers were reviewed retrospectively. The age, sex, complete blood test, and pathological results were recorded. The patients who were diagnosed with other carcinomas, benign renal tumors, and missing data of age, complete blood test, and pathological results, were excluded. The patients were divided into two groups according to the T stage and Fuhrman grade, T1-2 and T3-4, G1-2 and G3-4. RESULTS There were 271 patients in the current study. The male to female ratio was 1.97 and the mean age of the patients was 59.37±11.62 years. Clear cell renal cell carcinoma was the most common subtype in 72.7% of the patients. Both the neutrophil to lymphocyte ratio and the platelet to lymphocyte ratio were significantly higher in patients with high-grade and advanced-stage disease than in the others. The receiver operating characteristic curve showed no significant difference between platelet to lymphocyte ratio and neutrophil to lymphocyte ratio to diagnose the high grade and stage of renal cell carcinoma. CONCLUSION The neutrophil to lymphocyte and platelet to lymphocyte ratios are easily accessible biomarkers which are used for the prognosis of malignancy. The current study found that these biomarkers may predict the pathological results during the preoperative period.
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Affiliation(s)
- Selahattin Çalışkan
- Department of Urology, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
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18
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Systematic Review of the Role of Cytoreductive Nephrectomy in the Targeted Therapy Era and Beyond: An Individualized Approach to Metastatic Renal Cell Carcinoma. Eur Urol 2019; 75:111-128. [DOI: 10.1016/j.eururo.2018.09.016] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/10/2018] [Indexed: 01/02/2023]
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19
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Position of cytoreductive nephrectomy in the setting of metastatic renal cell carcinoma patients: does the CARMENA trial lead to a paradigm shift? Bull Cancer 2019; 105 Suppl 3:S229-S234. [PMID: 30595151 DOI: 10.1016/s0007-4551(18)30377-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction > The role of cytoreductive nephrectomy (CN) in combination with targeted therapy has been debated after the results of the CARMENA trial. We decided to reassess the available evidence on the setting of CN in metastatic renal cell carcinoma (mRCC) patients. Methods > Critical review of the literature focusing on CN in mRCC patients. Results > Previous trials demonstrated a survival benefit of CN during the cytokine-era. In the targeted therapies-era, retrospective studies has confirmed the survival benefit of CN but presented inherent selection biases. Recently, the CARMENA trial showed that sunitinib alone was not inferior to CN plus sunitinib, and could be followed by subsequent CN in good-responders patients. CN is found to be a morbid surgery (perioperative mortality rate of 0-13% and major postoperative complications rate of 3-36%) and should be avoided in patients with primary refractory disease, using targeted therapy as a selection tool. Some parameters have been associated with shorter overall survival, leading to propose up-front CN only to patients with good performance status, a high-volume renal tumor and a low metastatic burden. Conclusions > While previous studies demonstrated a survival benefit of CN, the CARMENA trial showed that immediate CN was not necessary in some patients with mRCC, leading to a paradigm shift. Targeted therapy should be proposed as first line treatment, and the response to pre-surgical therapy could be used as a selection tool for subsequent decision of CN in good-responders patients.
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20
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Lyon TD, Gershman B, Shah PH, Thompson RH, Boorjian SA, Lohse CM, Costello BA, Cheville JC, Leibovich BC. Risk prediction models for cancer-specific survival following cytoreductive nephrectomy in the contemporary era. Urol Oncol 2018; 36:499.e1-499.e7. [PMID: 30228096 DOI: 10.1016/j.urolonc.2018.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/26/2018] [Accepted: 08/13/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION To develop a risk-stratification model for cancer-specific survival (CSS) following cytoreductive nephrectomy (CN) in the contemporary era. MATERIALS AND METHODS A retrospective review was performed of 313 patients who underwent CN for M1 renal cell carcinoma (RCC) from 1990 to 2010. To account for the introduction of targeted therapies, timing of surgery was classified as immunotherapy era (1990-2004) or contemporary era (2005-2010). Risk scores were developed to predict CSS using Cox proportional hazards regression models. RESULTS A total of 215 (69%) and 98 (31%) patients were treated in the immunotherapy and contemporary eras, respectively. Median follow-up among survivors was 9.6 years, during which time 291 patients died, including 279 from RCC. On multivariable analysis limited to preoperative features, age ≥ 75, (hazard ratio [HR] 1.9), female sex (HR 1.9), constitutional symptoms (HR 1.61), radiographic lymphadenopathy (HR 1.59), and IVC tumor thrombus (HR 1.65) were significantly associated with CSS. On multivariable analysis including pathologic features, the features above as well as coagulative necrosis (HR 1.51) and sarcomatoid differentiation (HR 1.44) were significantly associated with CSS (all P < 0.05). Risk scores were developed for each model and used to predict CSS according to era. Decision curve analysis revealed that the preoperative risk score conferred a net benefit over a treat-all or treat-none approach beyond a 1-year cancer-specific mortality threshold of 25%. CONCLUSIONS We developed risk scores to predict CSS for patients treated with CN in the contemporary era. Patients with poor predicted survival may consider avoiding CN as initial management.
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Affiliation(s)
| | - Boris Gershman
- Warren Alpert Medical School of Brown University, Providence, RI; Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI
| | - Paras H Shah
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Peyton CC, Abel EJ, Chipollini J, Boulware DC, Azizi M, Karam JA, Margulis V, Master VA, Matin SF, Raman JD, Sexton WJ, Wood CG, Spiess PE. The Value of Neutrophil to Lymphocyte Ratio in Patients Undergoing Cytoreductive Nephrectomy with Thrombectomy. Eur Urol Focus 2018; 6:104-111. [PMID: 30206003 DOI: 10.1016/j.euf.2018.08.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/13/2018] [Accepted: 08/27/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND The neutrophil-lymphocyte ratio (NLR) is an established signature of inflammation used for evaluating renal cell carcinoma (RCC). OBJECTIVE To determine the utility of NLR and its relationship with known risk factors associated with poor survival in patients with metastatic RCC and tumor thrombus undergoing cytoreductive nephrectomy (CN). DESIGN, SETTING, AND PARTICIPANTS Prognostic variables were reviewed for patients undergoing CN with thrombectomy between 2000 and 2014 from six different institutions. Patients were stratified for NLR >4.0 based on cut point analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Kaplan-Meier curves compared overall survival of the total cohort and established risk models (Memorial Sloan Kettering Cancer Center [MSKCC], International Metastatic Renal-Cell Carcinoma Database Consortium [IMDC], and M.D. Anderson Cancer Center [MDACC]) stratified by NLR. Multivariable Cox regression determined predictors of overall survival. Receiver operator characteristic curves tested the predictive accuracy of survival ≥12 mo, and area under the curve (AUC) was compared between models. RESULTS AND LIMITATIONS In total, 332 patients were identified. Patients with NLR ≤4.0 had longer median survival (24.7 vs 15.2 mo, p=0.004). NLR >4.0 distinguished patients with significantly shorter survival for non-poor-risk groups defined by MSKCC, IMDC, and MDACC criteria. Systemic symptoms, low hemoglobin, elevated lactate dehydrogenase, retroperitoneal adenopathy, level IV thrombus, elevated absolute neutrophil count, and NLR >4 were independent predictors of decreased survival (p<0.05). These factors had higher predictive accuracy for survival at 12 mo (AUC=0.755) than MKSCC, IMDC, and MSKCC models. CONCLUSIONS NLR >4.0 independently predicts poor survival and further distinguishes established risk model survival curves. We identified seven preoperative risk factors related to poor survival for patients with metastatic RCC with tumor thrombus undergoing CN. PATIENT SUMMARY The neutrophil-lymphocyte ratio and six additional preoperative variables can be used to better council patients regarding survival after surgery for metastatic renal cell carcinoma with tumor thrombus.
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Affiliation(s)
- Charles C Peyton
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
| | - E Jason Abel
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Juan Chipollini
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - David C Boulware
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Mounsif Azizi
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jose A Karam
- University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Vitaly Margulis
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Surena F Matin
- University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jay D Raman
- Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Wade J Sexton
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
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22
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Bilen MA, Dutcher GMA, Liu Y, Ravindranathan D, Kissick HT, Carthon BC, Kucuk O, Harris WB, Master VA. Association Between Pretreatment Neutrophil-to-Lymphocyte Ratio and Outcome of Patients With Metastatic Renal-Cell Carcinoma Treated With Nivolumab. Clin Genitourin Cancer 2018; 16:e563-e575. [PMID: 29402706 PMCID: PMC5970007 DOI: 10.1016/j.clgc.2017.12.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/18/2017] [Accepted: 12/29/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Biomarkers to guide treatment in metastatic renal-cell carcinoma (mRCC) are lacking. We aimed to investigate the association between pretreatment neutrophil-to-lymphocyte ratio (NLR) and outcome of patients with mRCC receiving nivolumab. PATIENTS AND METHODS Through retrospective chart review, we identified 38 patients with mRCC treated with standard-of-care nivolumab between 2015 and 2016 at Winship Cancer Institute of Emory University. NLR was determined from complete blood count collected before starting treatment, and imaging was performed to assess progression. The NLR cutoff value of 5.5 was determined by log-rank test, and the univariate association with overall survival (OS) or progression-free survival (PFS) was assessed by the Cox proportional hazard model and Kaplan-Meier method. RESULTS The 38 patients had a median age of 69 years. The PFS and OS for all patients at 12 months was 54% and 69%, respectively. The median PFS was 2.6 months in the high NLR group but not reached in the low NLR group. Low NLR was strongly associated with increased PFS with hazard ratio of 0.20 (95% confidence interval, 0.07-0.64; P = .006). The median OS was 2.7 months in the high NLR group but not reached in the low NLR group. Low NLR was significantly associated with a prolonged OS with hazard ratio of 0.06 (95% confidence interval, 0.01-0.55; P = .012). CONCLUSION Pretreatment NLR < 5.5 is associated with superior PFS and OS. NLR is a biomarker that can inform prognosis for patients with mRCC and should be further validated in larger cohorts and in prospective studies.
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Affiliation(s)
- Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
| | | | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Deepak Ravindranathan
- Department of Medicine, Internal Medicine Residency Program, Emory University, Atlanta, GA
| | | | - Bradley C Carthon
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Wayne B Harris
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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23
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Grimes N, Hannan C, Tyson M, Thwaini A. The role of neutrophil-lymphocyte ratio as a prognostic indicator in patients undergoing nephrectomy for renal cell carcinoma. Can Urol Assoc J 2018; 12:E345-E348. [PMID: 29603920 DOI: 10.5489/cuaj.4872] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Prognosis in patients with cancer is influenced by underlying tumour biology and also the host inflammatory response to the disease. There is limited evidence to suggest that an elevated neutrophil-lymphocyte ratio (NLR) predicts a poorer prognosis in patients undergoing nephrectomy for renal cell carcinoma (RCC). The aim of this paper is to investigate if patients undergoing nephrectomy for RCC with NLR ≤4 have a better overall and recurrence-free survival than patients with NLR >4. METHODS All patients who underwent nephrectomy at a single centre between January 1, 2011 and December 31, 2014 were identified. Patients were included if postoperative histology demonstrated RCC and if preoperative NLR was available. Patients were excluded if nephrectomy was not curative intent (i.e., cytoreductive nephrectomy), if primary tumour was graded to be T3b-4 disease, if there was presence of nodal or metastatic disease on preoperative staging, or if adequate followup notes were not available. Primary and secondary outcomes were overall survival and recurrence-free survival, respectively. RESULTS A total of 154 patients were included in analysis of overall survival; 146 patients were included in analysis of recurrence-free survival. Patients with NLR ≤4 had a much better overall survival than patients with NLR >4 (95% vs. 78%; p=0.0219). Patients with NLR >4 also had higher rates of recurrence (p=0.0218). CONCLUSIONS NLR may be a useful tool in identifying patients who may benefit from more frequent surveillance in the early postoperative period and may allow clinicians to offer surveillance schemes tailored to the individual patient.
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Affiliation(s)
| | | | - Matthew Tyson
- Craigavon Area Hospital, Craigavon, Northern Ireland
| | - Ali Thwaini
- Belfast City Hospital, Belfast, Northern Ireland
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24
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Jeyakumar G, Kim S, Bumma N, Landry C, Silski C, Suisham S, Dickow B, Heath E, Fontana J, Vaishampayan U. Neutrophil lymphocyte ratio and duration of prior anti-angiogenic therapy as biomarkers in metastatic RCC receiving immune checkpoint inhibitor therapy. J Immunother Cancer 2017; 5:82. [PMID: 29041991 PMCID: PMC5646127 DOI: 10.1186/s40425-017-0287-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/03/2017] [Indexed: 01/05/2023] Open
Abstract
Background There is an unmet need to determine factors predictive of clinical benefit, to guide therapeutic sequencing and selection in metastatic RCC (mRCC). We evaluated clinical factors such as the neutrophil lymphocyte ratio (NLR) and duration of prior anti-vascular endothelial growth factor (VEGF) inhibitors, as predictors of response rate, progression free survival (PFS) and overall survival (OS) in mRCC patients treated with immune checkpoint inhibitor (ICI). Methods Regulatory approval was obtained. A single center retrospective chart review of mRCC patients at Karmanos Cancer Institute, treated with ICI based therapy (PD-1/PD-L1 inhibitors) was conducted. Data were collected on demographics, smoking status, prognostic scoring (Memorial Sloan Kettering and Heng criteria), NLR pretherapy, post 1 and 4 doses of ICI, and duration of prior anti-VEGF therapy ≥6 months or <6. Results 42 patients were evaluated with median age of 61 years (range, 24-85). Pretherapy NLR < 3 and ≥3 was seen in 19 (45%) and 23 (55%) patients, respectively. 24 (57%) and 18 (43%) patients had prior anti-VEGF inhibitors for a duration of ≥6 months and <6 months, respectively. 12 (29%), 22 (52%) and 8 (19%) patients had favorable, intermediate and poor risk disease based on Heng criteria, respectively. Multivariable analysis showed pretherapy NLR ≥3 was predictive of shorter PFS and OS when treated with ICI with median 3.08 months and 13.50 months, respectively, versus 15.57 months and not reached for NLR < 3 (adjusted p-values =0.003 and 0.025, respectively). Prior anti-VEGF therapy <6 months was predictive of increased likelihood of benefit from ICI therapies (adjusted p = 0.028). The median PFS was 3.72 months and 14.33 months, respectively, in cases with prior anti-VEGF therapy for ≥6 months and <6 months. Conclusion Pretherapy NLR <3 and duration of prior anti-VEGF therapy of <6 months, are independent statistically significant predictors of longer PFS and OS with ICI therapy in mRCC. Validation is required in a larger sample size with multi-institutional collaboration. Electronic supplementary material The online version of this article (10.1186/s40425-017-0287-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ghayathri Jeyakumar
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4 HWCRC 4100 John R, Detroit, MI, 48201, USA
| | - Seongho Kim
- Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Naresh Bumma
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4 HWCRC 4100 John R, Detroit, MI, 48201, USA
| | - Craig Landry
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4 HWCRC 4100 John R, Detroit, MI, 48201, USA
| | - Cynthia Silski
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4 HWCRC 4100 John R, Detroit, MI, 48201, USA
| | - Stacey Suisham
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4 HWCRC 4100 John R, Detroit, MI, 48201, USA
| | - Brenda Dickow
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4 HWCRC 4100 John R, Detroit, MI, 48201, USA
| | - Elisabeth Heath
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4 HWCRC 4100 John R, Detroit, MI, 48201, USA
| | - Joseph Fontana
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4 HWCRC 4100 John R, Detroit, MI, 48201, USA
| | - Ulka Vaishampayan
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4 HWCRC 4100 John R, Detroit, MI, 48201, USA.
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