Neutrophil-to-Lymphocyte Ratio May Be Associated With mRCC Outcomes
April 26, 2012
Two recent studies have reported on the possible utility of assessing pre-treatment neutrophil-to-lymphocyte ratio (NLR) as a prognostic factor in mRCC. Preliminary studies of NLR changes from baseline have suggested that it may be prognostic of outcomes for a variety of solid tumours, including hepatic, gastric, lung and breast cancers (Chen et al. J Gastroenterol Hepatol 2011, epublished September 13, 2011; www.ncbi.nlm.nih.gov/pubmed/21913982. Aizawa et al. World J Surg 2011; 35:2717-2722; www.ncbi.nlm.nih.gov/pubmed?term=Aizawa%202717. Tomita et al. Anticancer Res 2011;31:2995-2998; www.ncbi.nlm.nih.gov/pubmed/21868550. Azab et al. Ann Surg Oncol 2012;19:217-224; www.ncbi.nlm.nih.gov/pubmed/21638095 ).
The association of pre-treatment NLR with clinical outcomes (response rate, PFS, OS) was assessed in a retrospective analysis of an unselected cohort of 109 mRCC patients treated with sunitinib during the period 2004-2011 (Keizman et al. Eur J Cancer 2012;48:202-208; www.ncbi.nlm.nih.gov/pubmed/22018713). Low NLR was associated with PFS (HR 0.285) and OS (HR 0.3). Other factors associated with PFS were nephrectomy, sunitinib dose reduction or treatment interruption, and the use of angiotensin inhibitors.
A separate review of 250 patient records examined whether a change in NLR post-treatment had a clinical impact (Ohno et al. J Urol 2012;187:411-417; www.ncbi.nlm.nih.gov/pubmed/22177153). All subjects had non-metastatic clear-cell RCC. The 10-year recurrence-free survival rate was significantly lower in patients with preoperative NLR >2.7 versus < 2.7 (64.4% vs. 83.7%). Combining pre-and postoperative NLR provided further prognostic value. The 10-year RFS was significantly lower in patients with preoperative NLR >2.7 and postoperative NLR < 2.7 compared to those with preoperative and postoperative NLR >2.7 (52.0% vs. 83.5%).
Among patients with recurrence, the ratio at recurrence was significantly increased compared to the postoperative ratio. Tumour size, stage and NLR ratio (combining pre- and postoperative ratios) were independent predictors of recurrence on multivariate analysis.
Filed Under: Uncategorized