title: Markers of systemic inflammation predict survival in patients with advanced renal cell cancer.
abstract: BACKGROUND
  The host inflammatory response has a vital role in carcinogenesis and tumour progression. We examined the prognostic value of inflammatory markers (albumin, white-cell count and its components, and platelets) in pre-treated patients with advanced renal cell carcinoma (RCC).
  
  
  METHODS
  Using data from a randomised trial, multivariable proportional hazards models were generated to examine the impact of inflammatory markers and established prognostic factors (performance status, calcium, and haemoglobin) on overall survival (OS). We evaluated a new prognostic classification incorporating additional information from inflammatory markers.
  
  
  RESULTS
  Of the 416 patients, 362 were included in the analysis. Elevated neutrophil counts, elevated platelet counts, and a high neutrophil-lymphocyte ratio were significant independent predictors for shorter OS in a model with established prognostic factors. The addition of inflammatory markers improves the discriminatory value of the prognostic classification as compared with established factors alone (C-statistic 0.673 vs 0.654, P=0.002 for the difference), with 25.8% (P=0.004) of patients more appropriately classified using the new classification.
  
  
  CONCLUSIONS
  Markers of systemic inflammation contribute significantly to prognostic classification in addition to established factors for pre-treated patients with advanced RCC. Upon validation of these data in independent studies, stratification of patients using these markers in future clinical trials is recommended.
authors.affiliation: Central West Cancer Service, Orange, NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Fox
authors.forename: M
authors.initials: M
authors.lastname: Hudson
authors.forename: C
authors.initials: C
authors.lastname: Brown
authors.forename: S
authors.initials: S
authors.lastname: Lord
authors.forename: V
authors.initials: V
authors.lastname: Gebski
authors.forename: P
authors.initials: P
authors.lastname: De Souza
authors.forename: C K
authors.initials: CK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D005260:Female; D006801:Humans; D007249:Inflammation; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D000077341:Lapatinib; D007958:Leukocyte Count; D008297:Male; D019290:Megestrol Acetate / Q000627:therapeutic use; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D011799:Quinazolines / Q000627:therapeutic use; D012709:Serum Albumin / Q000032:analysis; D013629:Tamoxifen / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D011799:Quinazolines; D012709:Serum Albumin; D013629:Tamoxifen; D000077341:Lapatinib; D019290:Megestrol Acetate