title: Comprehensive analysis and validation of contemporary survival prognosticators in Korean patients with metastatic renal cell carcinoma treated with targeted therapy: prognostic impact of pretreatment neutrophil-to-lymphocyte ratio.
abstract: OBJECTIVE
  In line with the era of targeted therapy (TT), an increasing number of prognosticators are becoming available for patients with metastatic renal cell carcinoma (mRCC). Here, potential prognosticators of cancer-specific survival (CSS) were identified based on the contemporary literature and were comprehensively validated in an independent cohort of patients treated for mRCC.
  
  
  METHODS
  Data were collected from 478 patients treated with TT for mRCC between January 1999 and July 2013 at a single institution. The analysis included 25 clinicopathological covariates that included both traditional and contemporary prognosticators. Multivariate Cox regression models were used to quantify the effect of covariates on CSS.
  
  
  RESULTS
  Median survival from the initial diagnosis of metastasis was 24.5 (IQR, 11.5-55.7) months. There were 303 (63.4 %) cancer-specific deaths, yielding a 2-year CSS rate of 62.5 %. Low Karnofsky performance status (KPS), hypercalcemia, neutrophil-to-lymphocyte ratio (NLR), the number of metastatic sites (≥2), and the presence of brain metastases were independent adverse prognosticators of CSS. The C-index of the model was 0.78. Patients with at least one adverse prognosticator demonstrated lower 2-year CSS rates compared to those with no prognosticators (53.9 vs. 70.6 %; log rank p < 0.001).
  
  
  CONCLUSIONS
  Together with traditional prognosticators such as KPS, hypercalcemia, and the number and location of metastases, the NLR was an independent predictor of CSS in patients with mRCC treated with TT. Our findings could be useful for guiding clinical decision making including stratification of patients for TT and inclusion in clinical trials.
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, Republic of Korea.
authors.forename: Kyo Chul
authors.initials: KC
authors.lastname: Koo
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, Republic of Korea.
authors.forename: Kwang Suk
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, Republic of Korea.
authors.forename: Kang Su
authors.initials: KS
authors.lastname: Cho
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, Republic of Korea.
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, Republic of Korea.
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, Republic of Korea. chung646@yuhs.ac.
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
mesh_terms: D044466:Asian People; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D058990:Molecular Targeted Therapy; D009504:Neutrophils; D011379:Prognosis; D056910:Republic of Korea; D015996:Survival Rate
keywords: Nephrectomy; Prognostic factors; Renal cell carcinoma