title: Pre-treatment neutrophil-to-lymphocyte ratio may be associated with the outcome in patients treated with everolimus for metastatic renal cell carcinoma.
abstract: BACKGROUND
  Everolimus is a mammalian target of rapamycin inhibitor approved for the treatment of metastatic renal cell carcinoma (mRCC). We aimed to assess the association between pre-treatment neutrophil-to-lymphocyte ratio (NLR) and the outcome of patients treated with everolimus for mRCC.
  
  
  METHODS
  Ninety-seven patients with mRCC were treated with everolimus till April 2013 in our institutions. Patients were stratified in two groups with NLR >3 (Group A) vs <3 (Group B). Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier method. Gender, age, Motzer prognostic group, PFS on first-line therapy, neutrophilia and NLR were included in the Cox analysis to investigate their prognostic relevance.
  
  
  RESULTS
  Median OS and PFS were 10.6 and 5.3 months, respectively. Median OS was 12.2 months in Group A and 24.4 months in Group B (P=0.001). Median PFS was 3.4 months in Group A and 9.9 months in Group B (P<0.001). At multivariate analysis, only Motzer prognostic group and NLR were independent prognostic factors for OS and PFS.
  
  
  CONCLUSIONS
  Pre-treatment NLR is an independent prognostic factor for patients with mRCC treated with second- or third-line everolimus. This should be investigated and validated in prospective studies.
authors.affiliation: Clinica di Oncologia Medica, AOU 'Ospedali Riuniti', Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Santoni
authors.forename: U
authors.initials: U
authors.lastname: De Giorgi
authors.forename: R
authors.initials: R
authors.lastname: Iacovelli
authors.forename: A
authors.initials: A
authors.lastname: Conti
authors.forename: L
authors.initials: L
authors.lastname: Burattini
authors.forename: L
authors.initials: L
authors.lastname: Rossi
authors.forename: S
authors.initials: S
authors.lastname: Luca Burgio
authors.forename: R
authors.initials: R
authors.lastname: Berardi
authors.forename: G
authors.initials: G
authors.lastname: Muzzonigro
authors.forename: E
authors.initials: E
authors.lastname: Cortesi
authors.forename: D
authors.initials: D
authors.lastname: Amadori
authors.forename: S
authors.initials: S
authors.lastname: Cascinu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality; D018572:Disease-Free Survival; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009504:Neutrophils / Q000166:cytology*; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013534:Survival; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus