title: Lymphopenia is an independent predictor of inferior outcome in papillary renal cell carcinoma.
abstract: OBJECTIVE
  Lymphopenia as a likely index of poor systemic immunity is an independent predictor of inferior outcome in patients with clear cell renal cell carcinoma (RCC). We sought to evaluate the prognostic relevance of preoperative absolute lymphocyte count (ALC) in a cohort of patients with papillary RCC (PRCC).
  
  
  METHODS
  A prospectively maintained, renal cancer database was analyzed. Patients with preoperative ALC, within 3 months before surgery, were eligible for the study. Those with multifocal or bilateral renal tumors were excluded. Correlations between ALC and age, gender, smoking, Charlson comorbidity index, pathologic T category, PRCC subtype, and TNM stage were evaluated. Differences in overall survival (OS) and cancer-specific survival by ALC status were assessed using the log-rank test and cumulative incident estimators, respectively. Cox proportional hazards model was used for multivariable analyses.
  
  
  RESULTS
  A total of 192 patients met the inclusion criteria. As a continuous variable, preoperative ALC was associated with higher TNM stage (P = 0.001) and older age (P = 0.01). As a dichotomous variable, lymphopenia (<1,300 cells/µl) was associated with higher TNM stage (P = 0.003). On multivariable analyses, controlling for covariates, after a median follow-up of 37.3 months, lymphopenia was associated with inferior OS (hazard ratio = 2.3 [95% CI: 1.2-4.3], P = 0.011) and trended to significance for cancer-specific survival (P = 0.071). Among patients with nonmetastatic disease and lymphopenia, OS at 37.5 months was shorter compared with those with normal ALC (83% vs. 93%, P = 0.0006).
  
  
  CONCLUSIONS
  In patients with PRCC, lymphopenia is associated with lower survival independent of TNM stage, age, and histology. ALC may provide an additional preoperative prognostic factor.
authors.affiliation: Department of Urology & Oncological Science, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Reza
authors.initials: R
authors.lastname: Mehrazin
authors.affiliation: Department of Urologic Oncology, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
authors.affiliation: Department of Urologic Oncology, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
authors.affiliation: Division of Biostatistics, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA.
authors.forename: Karen
authors.initials: K
authors.lastname: Ruth
authors.affiliation: Department of Urologic Oncology, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Tomaszewski
authors.affiliation: Division of Pathology, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA.
authors.forename: Essel
authors.initials: E
authors.lastname: Dulaimi
authors.affiliation: Department of Urologic Oncology, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA.
authors.forename: Serge
authors.initials: S
authors.lastname: Ginzburg
authors.affiliation: Department of Urologic Oncology, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Abbosh
authors.affiliation: Department of Urologic Oncology, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Urologic Oncology, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA.
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Corcoran
authors.affiliation: Department of Urologic Oncology, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA.
authors.forename: David Y T
authors.initials: DY
authors.lastname: Chen
authors.affiliation: Department of Urologic Oncology, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.affiliation: Division of Pathology, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA. Electronic address: T_Alsaleem@fccc.edu.
authors.forename: Tahseen
authors.initials: T
authors.lastname: Al-Saleem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000276:immunology* / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology*; D008231:Lymphopenia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models
keywords: Biomarker; Inflammatory disease; Lymphocyte count; Lymphopenia; Papillary renal cell carcinoma; Renal cell carcinoma; Survival