title: Prognostic significance of host immune status in patients with late relapsing renal cell carcinoma treated with targeted therapy.
abstract: We aimed to assess the prognostic role of pretreatment neutrophilia, lymphocytopenia, and neutrophil to lymphocyte ratio (NLR) in patients treated with vascular endothelial growth factor-tyrosine kinase inhibitors (VEGFR-TKIs) for late relapsing (>5 years) metastatic renal cell carcinoma (mRCC). Data were collected from 13 Italian centers involved in the treatment of metastatic RCC. Late relapse was defined as >5 years after initial radical nephrectomy. One hundred fifty-one patients were included in this analysis. Among them, MSKCC risk score was favorable in 68 %, intermediate in 29 %, and poor in 3 %. Fifty-six patients (37 %) had NLR ≥3 at the start of VEGFR-TKI therapy (group A), while 95 had lower NLR (63 %, group B). The median overall survival (OS) was 28.8 months in group A and 68.7 months (95 % confidence interval (CI) 45.3-NA) in group B (p < 0.001). The median progression-free survival (PFS) was 15.8 months in group A and 25.1 months in group B (p = 0.03). At multivariate analysis, MSKCC risk group and NLR were independent prognostic factors for both OS and PFS. Pretreatment NLR is an independent prognostic factor for patients with late relapsing mRCC treated with first-line VEGFR-TKIs. A better characterization of baseline immunological impairment may optimize the management of this RCC subpopulation.
authors.affiliation: Medical Oncology, AOU Ospedali Riuniti, Polytechnic University of the Marche Region, Via Conca 71, 60126, Ancona, Italy. mattymo@alice.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Santoni
authors.affiliation: Oncology Unit, University Hospital of Parma, Viale Antonio Gramsci 14, 43126, Parma, Italy. sebabuti@libero.it.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Buti
authors.affiliation: Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Clinica di Urologia, AOU "Ospedali Riuniti", Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy. alessandro83conti@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Conti
authors.affiliation: Medical Oncology, IRCCS San Matteo University Hospital Foundation, Piazzale C Golgi 19, 27100, Pavia, Italy. camillo.porta@gmail.com.
authors.forename: Camillo
authors.initials: C
authors.lastname: Porta
authors.affiliation: Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via G. Venezian, Milan 1, 20133, Italy. Giuseppe.Procopio@istitutotumori.mi.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Procopio
authors.affiliation: Department of Medical Oncology, San Camillo and Forlanini Hospitals, Circonvallazione Gianicolense XX, Rome, 00152, Italy. cora.sternberg@pansadoro.it.
authors.forename: Cora N
authors.initials: CN
authors.lastname: Sternberg
authors.affiliation: Department of Oncology, Ospedale San Donato USL-8, Istituto Toscano Tumori (ITT), Via Pietro Nenni, 20, 52100, Arezzo, Italy. sergio.bracarda@usl8.toscana.it.
authors.forename: Sergio
authors.initials: S
authors.lastname: Bracarda
authors.affiliation: Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Via Gattamelata, 64, 35128, Padova, Italy. umberto.basso@ioveneto.it.
authors.forename: Umberto
authors.initials: U
authors.lastname: Basso
authors.affiliation: IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori-I.R.S.T., Via Piero Maroncelli 40, 47014, Meldola, FC, Italy. ugo.degiorgi@irst.emr.it.
authors.forename: Ugo
authors.initials: U
authors.lastname: De Giorgi
authors.affiliation: Department of Medical Oncology, Cardarelli Hospital, via Cardarelli 9, 80131, Naples, Italy. rizzo.mimma@gmail.com.
authors.forename: Mimma
authors.initials: M
authors.lastname: Rizzo
authors.affiliation: UO Oncologia Medica 2 Azienda Ospedaliero, Universitaria Pisana Istituto Toscano Tumori, Via Roma 67, 56100, Pisa, Italy. deros.lisa@gmail.com.
authors.forename: Lisa
authors.initials: L
authors.lastname: Derosa
authors.affiliation: Oncology Foundation of Piedmont, Institute for Cancer Research and Treatment, Laboratory Medicine, Via Orbassano 6, 10060, Candiolo, Italy. cinzia.ortega@gmail.com.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Ortega
authors.affiliation: Medical Oncology, 'G.B. Rossi' Academic Hospital, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy. fmassari79@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Massari
authors.affiliation: Medical Oncology A, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. milella@ifo.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Milella
authors.affiliation: Oncology Unit, University Hospital of Parma, Viale Antonio Gramsci 14, 43126, Parma, Italy.
authors.forename: Melissa
authors.initials: M
authors.lastname: Bersanelli
authors.affiliation: Department of Medical Oncology, San Camillo and Forlanini Hospitals, Circonvallazione Gianicolense XX, Rome, 00152, Italy. cerbone.linda@gmail.com.
authors.forename: Linda
authors.initials: L
authors.lastname: Cerbone
authors.affiliation: Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Clinica di Urologia, AOU "Ospedali Riuniti", Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy. g.muzzonigro@univpm.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Muzzonigro
authors.affiliation: Medical Oncology, AOU Ospedali Riuniti, Polytechnic University of the Marche Region, Via Conca 71, 60126, Ancona, Italy. l.burattini@ospedaliriuniti.marche.it.
authors.forename: Luciano
authors.initials: L
authors.lastname: Burattini
authors.affiliation: Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, AOU Ospedali Riuniti, via Conca 71, 60126, Ancona, Italy. r.montironi@univpm.it.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Montironi
authors.affiliation: Oncologia Medica, University Campus Bio-Medico Roma, Via Álvaro del Portillo 200, 00128, Rome, Italy. d.santini@unicampus.it.
authors.forename: Daniele
authors.initials: D
authors.lastname: Santini
authors.affiliation: Medical Oncology, AOU Ospedali Riuniti, Polytechnic University of the Marche Region, Via Conca 71, 60126, Ancona, Italy. s.cascinu@univpm.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000097:blood / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000276:immunology* / Q000473:pathology / Q000628:therapy; D007960:Leukocyte Disorders / Q000276:immunology / Q000473:pathology; D008231:Lymphopenia / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009364:Neoplasm Recurrence, Local / Q000276:immunology / Q000473:pathology; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D047428:Protein Kinase Inhibitors; D040262:Receptors, Vascular Endothelial Growth Factor
keywords: Late recurrence; Neutrophil to lymphocyte ratio; Prognosis; Renal cell carcinoma; Tyrosine kinase inhibitors