title: Post-treatment neutrophil-to-lymphocyte ratio in predicting prognosis in patients with metastatic clear cell renal cell carcinoma receiving sunitinib as first line therapy.
abstract: OBJECTIVE
  Neutrophil-to-lymphocyte ratio (NLR) was evaluated as a prognostic factor in patients with metastatic clear cell renal cell carcinoma (RCC) receiving sunitinib as first line therapy.
  
  
  METHODS
  Between December 2005 and December 2011, 109 patients with metastatic clear cell RCC were treated with sunitinib. The values of NLR were assessed at two time points: at baseline (pre-treatment) and on day 1 of the second cycle (post-treatment). The prognostic significance of NLR on treatment outcome was evaluated with adjustment for known confounding risk factors.
  
  
  RESULTS
  The median follow-up duration after sunitinib treatment was 24 months. There was no association between the pre-treatment NLR and tumor response (median pre-treatment NLRs: 2.2 for partial response [PR], 2.3 for stable disease [SD], and 1.9 for progressive disease [PD]; p = 0.531). However, lower post-treatment NLR (1.1 for PR, 1.2 for SD, 2.3 for PD; p = 0.021) and larger reduction in NLR after treatment (-45.8% for PR, -45.6% for SD, 14.8% for PD; p = 0.009) was significantly associated with a better tumor response. When the patients were divided into two subgroups according to the cutoff value of the post-treatment NLR 1.1, the differences in median cancer-specific survival were observed between subgroups (not reached vs. 19.0 months, p = 0.012). In multivariate analysis, body mass index, MSKCC risk group, serum hemoglobin, and post-treatment NLR were significantly associated with cancer-specific mortality.
  
  
  CONCLUSIONS
  Higher post-treatment NLR was associated with poor prognosis. An early reduction in the NLR after sunitinib treatment may indicate survival benefit in patients with metastatic clear cell RCC.
authors.affiliation: Department of Urology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Park
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, 101 Daehak-no, Jongno-gu, Seoul, 110-744 Korea.
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, 101 Daehak-no, Jongno-gu, Seoul, 110-744 Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, 101 Daehak-no, Jongno-gu, Seoul, 110-744 Korea.
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
keywords: Neutrophil-to-lymphocyte ratio; Renal cell carcinoma; Response; Sunitinib