title: Prognostic value of hematologic parameters in patients with metastatic renal cell carcinoma using tyrosine kinase inhibitors.
abstract: BACKGROUND
  The prognostic significance of the neutrophil-to-lymphocyte ratio for progression free survival in patients with metastatic renal cell carcinoma is unclear.
  
  
  METHODS
  We retrospectively reviewed 45 patients diagnosed with metastatic RCC previously treated with tyrosine kinase inhibitors from two centers, Akdeniz University Hospital and Afyon Kocatepe University. The prognostic value of the pretreatment neutrophil- tolymphocyte ratio, and other clinical and laboratory parameters were assessed by univariate and multivariate analysis.
  
  
  RESULTS
  Median progression free survival (PFS) was 13.9 months [95% CI for HR (6.88-20.91)] and overall survival figure of 16.6 months [95% CI for HR (7.23-26.03)] Univariate analysis revealed that PFS was significantly affected by hemoglobin level [p=0.013 (95% CI for HR (0.71-0.96))], eosinophil count [p=0.031 (95% CI for HR (0.20-0.92))], ratio of neutrophil lymphocytes (NLR) [p=0.007 (95% CI for HR (1.47-11.74))] and calcium level [p=0.006 (95% CI for HR (0.15-0.73))]. However, only NLR [p=0.031 (95% CI for HR (1.15- 18.1))] and calcium levels [p=0.018 (95% CI for HR (0.20-18.1))] retained significance with multivariate analysis. Median PFS was 23.9 vs 8.6 months in patients with NLR ≤ 2 vs NLR >2 (Log rank; p= 0.040).
  
  
  CONCLUSIONS
  This study showed that increased pretreatment NLR is an independent prognostic factor for patients with metastatic RCC using tyrosine kinase inhibitors.
authors.affiliation: Department of Medical Oncology, Faculty of Medicine, Akdeniz University, Antalya, Turkey E-mail : drsgunduz@gmail.com.
authors.forename: Seyda
authors.initials: S
authors.lastname: Gunduz
authors.forename: Hasan
authors.initials: H
authors.lastname: Mutlu
authors.forename: Mukremin
authors.initials: M
authors.lastname: Uysal
authors.forename: Hasan Senol
authors.initials: HS
authors.lastname: Coskun
authors.forename: Hakan
authors.initials: H
authors.lastname: Bozcuk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D015331:Cohort Studies; D018572:Disease-Free Survival; D004804:Eosinophils / Q000166:cytology*; D005260:Female; D006454:Hemoglobins; D006801:Humans; D007191:Indazoles; D007211:Indoles / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000166:cytology*; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use; D011379:Prognosis; D016016:Proportional Hazards Models; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D011743:Pyrimidines / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D012189:Retrospective Studies; D000077157:Sorafenib; D013449:Sulfonamides / Q000627:therapeutic use; D000077210:Sunitinib
chemical_list: D000970:Antineoplastic Agents; D006454:Hemoglobins; D007191:Indazoles; D007211:Indoles; D010671:Phenylurea Compounds; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D009536:Niacinamide; C516667:pazopanib; D000077157:Sorafenib; D011505:Protein-Tyrosine Kinases; D000077210:Sunitinib