Predictive value of De Ritis ratio in metastatic renal cell carcinoma treated with tyrosine-kinase inhibitors

Abstract

Background Predictive markers can help tailor treatment to the individual in metastatic renal cell carcinoma (mRCC). De Ritis ratio (DRR) is associated with oncologic outcomes in various solid tumors. Objective To assess the value of DRR in prognosticating survival in mRCC patients treated with tyrosine-kinase inhibitors (TKI). Methods Overall, 220 mRCC patients treated with TKI first-line therapy were analyzed. An optimal cut-off point for DRR was determined with Youden’s J. We used multiple strata for DRR, performed descriptive, Kaplan–Meier and multivariable Cox-regression analyses to assess associations of DRR with progression-free (PFS) and overall survival (OS). Results Patients above the optimal cut-off point for DRR of ≥ 1.58 had fewer liver metastases (p = 0.01). There was no difference in PFS (p > 0.05) between DRR groups. DRR above the median of 1.08 (HR 1.42; p = 0.03), DRR ≥ 1.1(HR 1.44; p = 0.02), ≥ 1.8 (HR 1.56; p = 0.03), ≥ 1.9 (HR 1.59; p = 0.02) and ≥ 2.0 (HR 1.63; p = 0.047) were associated with worse OS. These associations did not remain after multivariable adjustment. In the intermediate MSKCC group, DRR was associated with inferior OS at cut-offs ≥ 1.0 (HR 1.78; p = 0.02), ≥ 1.1 (HR 1.81; p = 0.01) and above median (HR 1.88; p = 0.007) in multivariable analyses. In patients with clear-cell histology, DRR above median (HR 1.54; p = 0.029) and DRR ≥ 1.1 (HR 1.53; p = 0.029) were associated with OS in multivariable analyses. Conclusion There was no independent association between DRR and survival of mRCC patients treated with TKI in the entire cohort. However, OS of patients with intermediate risk and clear-cell histology were affected by DRR. DRR could be used for tailored decision-making in these subgroups.

RNA-seq and Mitochondrial DNA Analysis of Adrenal Gland Metastatic Tissue in a Patient with Renal Cell Carcinoma

“…However, it is difficult to select Currently, drug treatments for metastatic RCC are diverse and stratified by risk factors using models such as those from the Memorial Sloan-Kettering Cancer Center and the International Metastatic RCC Database Consortium. However, it is difficult to select appropriate cases for study [8][9][10][11][12][13][14][15][16]. In addition, the effectiveness of therapeutic agents has been investigated primarily using nuclear gene information.…”

Potential Clinical Value of Pretreatment De Ritis Ratio as a Prognostic Biomarker for Renal Cell Carcinoma

“…A problem of the study by Su is their interpretation of OS since the data provided by the original research in their studies all indicated that an elevated De Ritis ratio had poor survival. Furthermore, a recent study reported that the De Ritis ratio was not associated with RCC prognosis (31). Thus, it is necessary to reevaluate the role of the De Ritis ratio in the prognosis of RCC based on the existing literature to better guide clinical practice.…”

“…After full-text evaluation, 12 studies were excluded from the remaining 25 potential studies, including 6 without survival outcomes, 3 without adequate survival data, and 5 without De Ritis ratio data. Finally, eleven articles comprising 6,258 patients were included in the present analysis (18,19,(23)(24)(25)(26)(27)(28)(29)(30)(31) (Figure 1). Table 1 records the basic characteristics of all included studies.…”

“…All studies had a retrospective design, two of which were propensity score-matched analyses. Five studies focused on metastatic RCC (24,26,27,30,31). Six studies focused on non-metastatic RCC (18,19,23,25,28,29).…”

“…Nine studies including 6,285 patients recorded about OS (18,19,(23)(24)(25)(26)(27)(29)(30)(31). Since moderate heterogeneity was found, the random-effect model was adopted (I2 = 34.6%, p = 0.131).…”