Lymphopenia is an independent predictor of inferior outcome in papillary renal cell carcinoma

Abstract

Purpose Lymphopenia as a likely index of poor systemic immunity is an independent predictor of inferior outcome in clear renal cell carcinoma (ccRCC). We sought to evaluate the prognostic relevance of preoperative absolute lymphocyte count (ALC) in a cohort of papillary renal cell carcinoma (PRCC) patients. Materials & Methods A prospectively maintained, renal cancer database was analyzed. Patients with preoperative ALC, within 3 months prior to surgery, were eligible for the study. Those with multifocal or bilateral renal tumors were excluded. Correlations between ALC and age, gender, smoking, Charlson comorbidity index (CCI), pathologic (pT) stage, PRCC subtype, and TNM stage were evaluated. Differences in overall survival (OS) & cancer-specific survival (CSS) by ALC status were assessed using the log–rank test and cumulative incident estimators, respectively. Cox proportional hazards modeling was used for multivariable analyses (MVA). Results 192 patients met the inclusion criteria As a continuous variable, preoperative ALC was associated with higher TNM stage (p=0.001) and older age (p=0.01). As a dichotomous variable, lymphopenia (<1,300 cells/μl) was associated with higher TNM stage (p=0.003). On MVA, controlling for covariates, after a median follow up of 37.3 months, lymphopenia was associated with inferior OS (HR=2.3 [95%CI 1.2–4.3], p=0.011) and trended to significance for CSS (p=0.071). Among non-metastatic, lymphopenic patients, OS at 37.5 months was shorter compared to those with normal ALC (83% vs. 93%, p=0.0006). Conclusions In patients with PRCC, lymphopenia is associated with lower survival independent of TNM stage, age, and histology. ALC may provide an additional pre-operative prognostic factor.

Lymphopenia Predicts Poor Prognosis in Patients With Esophageal Squamous Cell Carcinoma

“…Our study showed that lymphopenia was associated with N stage. This observation is in line with data from Saroha et al, 13 but is contrary to the result of Mehrazin et al, 19 who suggested that lymphopenia is not correlation with the N stage ( P = 0.120).…”

Association of the preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios with lymph node metastasis and recurrence in patients with medullary thyroid carcinoma

“…Lymphocytes play an important role in cell-mediated immune response activation and tumor cell demolition. [ 35 , 36 ]…”

Preoperative Neutrophil-to-Lymphocyte Ratio and Neutrophilia Are Independent Predictors of Recurrence in Patients with Localized Papillary Renal Cell Carcinoma

“…de Martino et al [ 13 ] showed that patients with increased preoperative NLR, evaluated as a continuous variable, had a high risk of disease recurrence in nonclear cell RCC. Mehrazin et al [ 14 ] demonstrated that patients with lymphopenia had an inferior overall survival and a trend significance for worse cancer-specific survival ( P = 0.071) in pRCC.…”

“…Only one study investigated NLR in nonclear cell RCC, but they did not analyze it in separate histologic subtype [ 13 ]. One recent study focused on ALC in pRCC [ 14 ].…”