Prognostic value of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma treated with first-line and subsequent second-line targeted therapy: A proposal of the modified-IMDC risk model.
The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk model has been designed for prognostification in patients with metastatic renal cell carcinoma (mRCC) treated with targeted therapy. One factor is neutrophil count; however, increasing evidence has suggested the superiority of neutrophil-to-lymphocyte ratio (NLR) for predicting outcome. In this study, we evaluate the prognostic effect of NLR levels on patients with mRCC treated with targeted therapy, and then we compare the predictive accuracy of the IMDC risk model and its modified one by using NLR, instead of neutrophil count.



A total of 277 patients are included for the analysis. All patients underwent targeted therapies and associated outcome are assessed using multivariate analysis.



Pretreatment NLR levels are elevated in 30.3% and 23.1% of patients in the first-line and subsequent second-line setting, respectively. Kaplan-Meier curves reveal that elevated pretreatment NLR is significantly associated with poor overall survival (OS) since first-line (P<0.001) and second-line targeted therapy administration (P<0.001). Also, multivariate analyses show that elevated pretreatment NLR is an independent predictor for poor OS since first-line and second-line targeted therapy administration. The addition of NLR to the IMDC risk model, instead of neutrophil count, significantly improves the predictive accuracy for OS, and estimated gain is 1.7% and 6.2% in first-line and second-line targeted therapy, respectively.



Changes in NLR levels could be predictive for prognosis in patients with mRCC treated with first-line and second-line targeted therapy. The addition of NLR significantly improves the predictive accuracy of the IMDC risk model in the first-line and subsequent second-line setting.
Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saitama City Hospital, Saitama, Japan. Electronic address: urotanaka@gmail.com.
Nobuyuki
N
Tanaka
Department of Urology, Keio University School of Medicine, Tokyo, Japan. Electronic address: mizunor@z7.keio.jp.
Ryuichi
R
Mizuno
Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.
Yota
Y
Yasumizu
Department of Urology, National Defense Medical College, Tokorozawa, Japan.
Keiichi
K
Ito
Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.
Suguru
S
Shirotake
Department of Urology, National Defense Medical College, Tokorozawa, Japan.
Ayako
A
Masunaga
Department of Urology, Saiseikai Central Hospital, Tokyo, Japan.
Yujiro
Y
Ito
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Yasumasa
Y
Miyazaki
Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Japan.
Masayuki
M
Hagiwara
Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan.
Kent
K
Kanao
Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan.
Shuji
S
Mikami
Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Japan.
Ken
K
Nakagawa
Department of Urology, National Hospital Organization Saitama Hospital, Wako, Japan.
Tetsuo
T
Momma
Department of Urology, Saitama City Hospital, Saitama, Japan.
Takeshi
T
Masuda
Department of Urology, National Defense Medical College, Tokorozawa, Japan.
Tomohiko
T
Asano
Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.
Masafumi
M
Oyama
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Mototsugu
M
Oya
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009504:Neutrophils / Q000473:pathology*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies
Metastasis; NLR; Neutrophil; Outcome; Prognosis; Renal cell carcinoma; Targeted therapy