C‐reactive protein/albumin ratio is a predictive factor for prognosis in patients with metastatic renal cell carcinoma

Konishi, Sakae; Hatakeyama, Shingo; Tanaka, Toshiaki; Ikehata, Yoshinori; Tanaka, Toshikazu; Hamano, Itsuto; Fujita, Naoki; Yoneyama, T.; Yamamoto, Hayato; Yoneyama, Takahiro; Hashimoto, Yasuhiro; Yoshikawa, Kunio; Kawaguchi, Toshiaki; Masumori, Naoya; Kitamura, Hiroshi; Οhyama, Chikara

doi:10.1111/iju.14078

Cited by 19 publications

(16 citation statements)

References 29 publications

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“…The main reason might be the short follow‐up periods and the regional bias in Japan. Approximately 1.5‐fold longer median survival time has been reported in previous studies in Japan than in North America or Europe 14,15,17–22 . Health insurance systems and racial differences could be possible reasons.…”

Section: Discussionmentioning

confidence: 82%

“…Approximately 1.5-fold longer median survival time has been reported in previous studies in Japan than in North America or Europe. 14,15,[17][18][19][20][21][22] Health insurance systems and racial differences could be possible reasons. The public health insurance system for its citizens in Japan covers almost every standard treatment, including surgery, targeted therapy and immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…As several studies have suggested the utility of CRP value on prognosis, it might be useful to consider the efficacy of nivolumab plus ipilimumab therapy. 17,22,[24][25][26][27] Further studies are necessary to validate the role of CRP value on the immunotherapy response. We found no ORR difference between patients with intermediate-risk 1 and 2 of IMDC in the present study.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of first‐line nivolumab plus ipilimumab in patients with metastatic renal cell carcinoma: A multicenter retrospective study

Tanaka¹,

Hatakeyama²,

Numakura³

et al. 2020

Int J of Urology

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To investigate the efficacy and safety of first-line nivolumab plus ipilimumab for patients treated with metastatic renal cell carcinoma. Methods: We retrospectively evaluated 52 metastatic renal cell carcinoma patients who were treated with nivolumab plus ipilimumab between August 2015 and January 2020. Data on patient characteristics, treatment parameters and adverse events were obtained. Oncological outcomes were assessed according to the International Metastatic Renal Cell Carcinoma Database Consortium prognostic model. Furthermore, differences in treatment parameters between patients with objective response (responders) and non-responders were compared. Results: The median age and follow-up periods were 69 years and 8.2 months, respectively. The 1-year progression-free survival and overall survival rates were 55% and 75%, respectively. The objective response rate was 39%, and it was significantly different between the International Metastatic Renal Cell Carcinoma Database Consortium intermediate-and poor-risk groups (52% vs 24%). We observed 36 (69%) any immunerelated adverse events, and 19 (37%) severe immune-related adverse events (grades III-V). The International Metastatic Renal Cell Carcinoma Database Consortium poor-risk group and higher value of initial C-reactive protein (≥1.0 mg/dL) were significantly associated with non-responders. Patients with two factors (the International Metastatic Renal Cell Carcinoma Database Consortium poor-risk group plus C-reactive protein ≥1.0 mg/dL) had a significantly poor overall survival than those with none or a single factor. Conclusions: In our experience, treatment response to nivolumab plus ipilimumab is comparable with that of the CheckMate 214 clinical trial, but the incidence of treatmentrelated adverse events is lower. The International Metastatic Renal Cell Carcinoma Database Consortium poor-risk group and initial C-reactive protein value might have a prognostic value for poor survival.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of first‐line nivolumab plus ipilimumab in patients with metastatic renal cell carcinoma: A multicenter retrospective study

Tanaka¹,

Hatakeyama²,

Numakura³

et al. 2020

Int J of Urology

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“…In previous studies, several prognostic markers for axitinib treatment have been suggested, such as NLR 25 , serum albumin level 26 , serum lactate dehydrogenase level 26 , and serum CRP level 27 , among others. However, the model-development cohorts for these studies consisted of heterogeneous populations that included patients who had received a variety of treatments, including several VEGFR-TKIs.…”

Section: Discussionmentioning

confidence: 99%

First-line axitinib therapy is less effective in metastatic renal cell carcinoma with spindle histology

Numakura

Kobayashi

Muto

et al. 2020

Sci Rep

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Axitinib, a vascular endothelial growth factor receptor-tyrosine kinase inhibitor, will be used in combination first-line therapies against metastatic renal cell carcinoma (mRCC), but its effects as a first-line monotherapy are unclear. Thus, we aimed to elucidate pretreatment clinical factors that predict the prognosis of patients with mRCC receiving first-line axitinib therapy. We enrolled 63 patients with mRCC treated with axitinib as first-line therapy between Nov. 2003 and Jul. 2018. Progression-free survival (PFS) and overall survival (OS) were assessed using the Wald χ2 statistic in Cox proportional hazards regression. Median patient age was 67 (range: 25–85) years. Seven (11.1%) patients were classified as being at favorable risk, 33 (52.4%) at intermediate risk, and 23 (36.5%) at poor risk according to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk classification system. Median follow-up duration after axitinib initiation was 14 (range: 1–72) months. Median PFS and OS were 18 months and 65 months, respectively. Cox regression analyses of clinical predictors revealed that high C-reactive protein (CRP) levels were significantly correlated with shorter PFS [hazard ratio (HR), 1.63; 95% confidence interval (CI) 1.7–4.0)], whereas spindle cells and poor IMDC risk scores were related to worse OS (HR, 2.87 and 2.88, respectively; 95% CI 1.4–11.0 and 1.1–8.5, respectively). Thus, patients with mRCC and spindle histology or poor IMDC risk scores had worse OS, and those with high CRP levels had shorter PFS in first-line axitinib treatment. Other therapies might be more suitable for initial management of such patients.

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“…Overall, 570 records, identified irrelevant by title and abstract screening, were excluded; and the remained 47 records, which investigated the correlation between CRP/Alb reactivity and survival outcomes of patients with RCC, were evaluated in full text. To meet our inclusion and exclusion criteria, six articles of five literatures [21][22][23][24][25] were eligible and eventually included in our study for analysis of the relationship between CRP/Alb and outcomes of the RCC patients. Our work flowchart is shown in Fig.…”

Section: Study Characteristicsmentioning

confidence: 99%

Prognostic value of C-reactive protein/albumin ratio in renal cell carcinoma: a systematic review and meta-analysis

Song

Xiang

Liu

et al. 2019

Preprint

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Background: There are a mass of studies declared the prognostic significance of C-reactive protein/albumin ratio (CRP/Alb) in renal cell carcinoma (RCC). Nevertheless, these works are controversial. In our study, we investigate the expression of CRP/Alb in RCC and its role in prognosis and clinicopathological features. Methods: The PubMed, Embase and Cochrane databases were searched systematically for correlative articles published before August 1, 2019. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined according to eligible studies. And we use fixed and random effects models to calculate on the basis of heterogeneity. Results: Six relevant studies were identified in this study, 1959 participants included in total. Our results showed that CRP/Alb was related to poor overall survival (HR=1.86, 95% CI: 1.56-2.21). In addition, CRP/Alb was also associated with tumor stage (OR=3.29, 95% CI: 1.66-6.50), lymph node involvement (OR=3.76, 95% CI: 2.57-5.51), metastasis (OR=5.69, 95% CI: 2.40-13.51), Fuhrman nuclear grade (OR=4.21, 95% CI: 3.14-5.64), pTNM (OR=4.34, 95% CI: 1.94-9.70) and tumor size (WMD=2.26, 95% CI: 1.86–2.67). However, CRP/Alb was not associated with necrosis. Conclusion: Our study illustrates that the higher CRP/Alb expression was correlated with poorer prognosis and more advanced clinicopathological features in RCC patients. High CRP/Alb expression may act as a valuable predictive biomarker for poor prognosis in RCC patients.

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C‐reactive protein/albumin ratio is a predictive factor for prognosis in patients with metastatic renal cell carcinoma

Cited by 19 publications

References 29 publications

Efficacy and safety of first‐line nivolumab plus ipilimumab in patients with metastatic renal cell carcinoma: A multicenter retrospective study

Efficacy and safety of first‐line nivolumab plus ipilimumab in patients with metastatic renal cell carcinoma: A multicenter retrospective study

First-line axitinib therapy is less effective in metastatic renal cell carcinoma with spindle histology

Prognostic value of C-reactive protein/albumin ratio in renal cell carcinoma: a systematic review and meta-analysis

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