Prognostic significance of the dynamic changes of systemic inflammatory response in metastatic renal cell carcinoma

Abstract

Purpose: To elucidate the prognostic value of systemic inflammatory response in patients with metastatic renal cell carcinoma (mRCC) who are treated with sunitinib, we evaluated the prognostic role of C-reactive protein (CRP) kinetics. This study also compared prognostic models containing CRP kinetics and neutrophil-to-lymphocyte ratio (NLR) kinetics. Materials and Methods: A consecutive cohort of 94 patients with mRCC who were treated with sunitinib was retrospectively included from Fudan University Shanghai Cancer Center. According to dynamic changes in CRP and the NLR, patients were divided into three groups for analysis of CRP and NLR kinetics. The associations between survival and potential prognostic factors were assessed. The incremental value of prognostication was evaluated. Results: A significant difference (P<0.001) in overall survival (OS) was observed among the three groups of CRP kinetics. The median OS of the non-elevated group was nearly 1.3-fold longer than that of the normalized group (33.0 vs. 26.3 months), and two times longer than that of the non-normalized group (33.0 vs. 14.0 months). Multivariate analysis showed that CRP and NLR kinetics were independent prognostic indicators. The model containing CRP kinetics had a better predictive accuracy than that with NLR kinetics, which was supported by the C-index (0.731 vs. 0.684) and the likelihood ratio χ 2 test (79.9% vs. 44.9%). Conclusion: Our study suggests that dynamic changes in CRP can better predict survival in patients with mRCC who are treated with sunitinib. Routine assessment of CRP before and after targeted therapy would help identify patients at risk of a poor outcome.

Neutrophil-to-Lymphocyte Ratio as a Prognostic Biomarker for Patients With Metastatic Renal Cell Carcinoma Treated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis

“…Lymphocyte infiltration in tumor tissue is associated with a better therapeutic response and outcome, while the decrease in lymphocytes in the tumor microenvironment leads to a decrease in antitumor ability, which causes the emergence of immune tolerance and the escape of tumor cells ( 41 ). In addition, the reduction in peripheral blood lymphocytes can provide an appropriate tumor microenvironment for the proliferation and metastasis of tumor cells by impairing the antitumor response mediated by lymphocytes ( 42 ). Theoretically, neutrophilia represents the response to systematic inflammation, whereas lymphocytes reflect an impaired cell-mediated immunity.…”

Survival nomogram for patients with bone metastatic renal cell carcinoma: A population-based study

“…For patients of different cancer types, the immune system will weaken with the increase of age and this will help tumor deterioration further reduce patient's survival (15). In practice, there was evidence proved that C-reactive protein (CRP) could predict the prognosis of mRCC patients (16). The prognosis of various cancer patients of different genders may be related to inconsistent hormone levels in the body (17), for example the testosterone, estrogen and progesterone level's change will cause specific cancer (18).…”

Prognostic value of preoperative combined neutrophil, monocyte, and lymphocyte scores in patients with renal cell carcinoma undergoing laparoscopic nephrectomy: A retrospective study

“…Tumor‐infiltrating lymphocytes had an important anti‐tumor immune role in the tumor microenvironment and were associated with better treatment response and outcome 20 . Previous studies have confirmed that the reduction of lymphocyte count in peripheral blood diminishes the immune response capacity of the body, leading to the emergence of immune tolerance and a decrease in host immune surveillance, and the escape of tumor cells leading to a decrease in the survival rate of tumor patients 31 . Based on previous studies, and the results we obtained, we found that low levels of monocytes and neutrophils, and high levels of lymphocytes were associated with a positive prognosis for patients with RCC who underwent laparoscopic nephrectomy.…”