title: Low CCL-21 expression associates with unfavorable postoperative prognosis of patients with metastatic renal cell carcinoma.
abstract: BACKGROUND
  Chemokine (C-C motif) ligand 21 (CCL21), a ligand of the chemokine (C-C motif) receptor 7, has recently been identified as an immuno-based anti-cancer molecule for its dendritic cells and T lymphocytes chemoattractant function. The aim of this study was to investigate prognostic values of CCL21 expression in metastatic renal cell carcinoma patients treated with targeted therapy.
  
  
  METHODS
  This study included 111 patients with metastatic renal cell carcinoma receiving targeted therapy. CCL21 expression was analyzed by immunohistochemistry on tissue microarrays. Prognostic value of tumoral CCL21 expression and patients' clinical outcomes were evaluated.
  
  
  RESULTS
  Kaplan-Meier method showed that low CCL21 expression was associated with shorter patient overall survival and progression-free survival (overall survival, P = 0.005; progression-free survival, P = 0.044). Further stratified analysis showed that low CCL21 expression was significantly associated with shorter overall survival in clear cell renal cell carcinoma patients (P = 0.017) and patients treated with sorafenib (P = 0.009). Low CCL21 expression was also an adverse independent risk factor for overall survival (hazard ratio, 2.106; 95% CI, 1.286-3.450; P = 0.003) and progression-free survival (hazard ratio 1.617; 95%CI 1.060-2.465; P = 0.026) in multivariate analyses. CCL21 expression was significantly associated with treatment best response to targeted therapy (P = 0.009). This molecule could also be combined with Heng risk model to increase its overall survival predictive accuracy.
  
  
  CONCLUSIONS
  Low CCL21 expression was a potential independent adverse prognostic biomarker for overall survival and progression-free survival for metastatic renal cell carcinoma patients treated with targeted therapy.
authors: Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Ying
authors: Y
authors: Xiong
authors: Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Li
authors: L
authors: Liu
authors: Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Jiajun
authors: J
authors: Wang
authors: Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Wei
authors: W
authors: Xi
authors: Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Yu
authors: Y
authors: Xia
authors: Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Qi
authors: Q
authors: Bai
authors: Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Yang
authors: Y
authors: Qu
authors: Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Qilai
authors: Q
authors: Long
authors: Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China.
authors: Jiejie
authors: J
authors: Xu
authors: Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Jianming
authors: J
authors: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000235:genetics* / Q000401:mortality* / Q000601:surgery; D054421:Chemokine CCL21 / Q000235:genetics* / Q000378:metabolism; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000235:genetics* / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011184:Postoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012307:Risk Factors; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D054421:Chemokine CCL21
keywords: CCL-21; metastatic renal cell carcinoma; overall survival; prognostic factor; progression-free survival