Journal article
Change in Neutrophil-to-lymphocyte Ratio in Response to Targeted Therapy for Metastatic Renal Cell Carcinoma as a Prognosticator and Biomarker of Efficacy.
- Templeton AJ Princess Margaret Cancer Center, Division of Medical Oncology, Toronto, ON, Canada; Kantonsspital St. Gallen, Department of Medical Oncolgoy and Hematology, St. Gallen, Switzerland.
- Knox JJ Princess Margaret Cancer Center, Division of Medical Oncology, Toronto, ON, Canada.
- Lin X Pfizer Oncology, Pfizer Inc., New York, NY, USA.
- Simantov R Pfizer Oncology, Pfizer Inc., New York, NY, USA.
- Xie W Dana Farber Cancer Institute, Biostatistics and Computational Biology, Boston, MA, USA.
- Lawrence N Auckland City Hospital, Auckland City Hospital, Grafton, Auckland, New Zealand.
- Broom R Auckland City Hospital, Auckland City Hospital, Grafton, Auckland, New Zealand.
- Fay AP Dana Farber Cancer Institute, Biostatistics and Computational Biology, Boston, MA, USA.
- Rini B Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA.
- Donskov F Aarhus University Hospital, Nørrebrogade, Aarhus, Denmark.
- Bjarnason GA Sunnybrook Odette Cancer Center, Toronto, ON, Canada.
- Smoragiewicz M British Columbia Cancer Agency, Vancouver, BC, Canada.
- Kollmannsberger C National Cancer Center Singapore, Singapore.
- Kanesvaran R Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB, Canada.
- Alimohamed N Princess Margaret Cancer Center, Division of Medical Oncology, Toronto, ON, Canada; Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB, Canada.
- Hermanns T Princess Margaret Cancer Center, Division of Medical Oncology, Toronto, ON, Canada.
- Wells JC Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB, Canada.
- Amir E Princess Margaret Cancer Center, Division of Medical Oncology, Toronto, ON, Canada.
- Choueiri TK Dana Farber Cancer Institute, Biostatistics and Computational Biology, Boston, MA, USA.
- Heng DY Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB, Canada. Electronic address: daniel.heng@albertahealthservices.ca.
- 2016-03-01
Published in:
- European urology. - 2016
Change
Conversion
Neutrophil-to-lymphocyte ratio
Prognosis
Renal cell carcinoma
Targeted therapy
Aged
Biomarkers
Carcinoma, Renal Cell
Drug Monitoring
Female
Humans
Leukocyte Count
Lymphocytes
Male
Middle Aged
Molecular Targeted Therapy
Neoplasm Metastasis
Neoplasm Staging
Neutrophils
Outcome Assessment, Health Care
Predictive Value of Tests
Prognosis
Proportional Hazards Models
English
BACKGROUND
Neutrophil-to-lymphocyte ratio (NLR), if elevated, is associated with worse outcomes in several malignancies.
OBJECTIVE
Investigation of NLR at baseline and during therapy for metastatic renal cell carcinoma.
DESIGN, SETTING, AND PARTICIPANTS
Retrospective analysis of 1199 patients from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC cohort) and 4350 patients from 12 prospective randomized trials (validation cohort).
INTERVENTION
Targeted therapies for metastatic renal cell carcinoma.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
NLR was examined at baseline and 6 (± 2) wk later. A landmark analysis at 8 wk was conducted to explore the prognostic value of relative NLR change on overall survival (OS), progression-free survival (PFS), and objective response rate using Cox or logistic regression models, adjusted for variables in IMDC score and NLR values at baseline.
RESULTS AND LIMITATIONS
Higher NLR at baseline was associated with shorter OS and PFS (Hazard Ratios [HR] per 1 unit increase in log-transformed NLR = 1.69 [95% confidence interval {CI} = 1.46-1.95] and 1.30 [95% CI = 1.15-1.48], respectively). Compared with no change (decrease < 25% to increase < 25%, reference), increase NLR at Week 6 by 25-50% and > 75% was associated with poor OS (HR=1.55 [95% CI=1.10-2.18] and 2.31 [95% CI=1.64-3.25], respectively), poor PFS (HR=1.46 [95% CI=1.04-2.03], 1.76 [95% CI=1.23-2.52], respectively), and reduced objective response rate (odds ratios = 0.77 [95% CI=0.37-1.63] and 0.24 [95% CI=0.08-0.72], respectively). By contrast, a decrease of 25-50% was associated with improved outcomes. Findings were confirmed in the validation cohort. The study is limited by its retrospective design.
CONCLUSIONS
Compared with no change, early decline of NLR is associated with favorable outcomes, whereas an increase is associated with worse outcomes.
PATIENT SUMMARY
We found that the proportion of immune cells in the blood is of prognostic value, namely that a decrease of the proportion of neutrophils-to-lymphocytes is associated with more favorable outcomes while an increase had the opposite effect.
Neutrophil-to-lymphocyte ratio (NLR), if elevated, is associated with worse outcomes in several malignancies.
OBJECTIVE
Investigation of NLR at baseline and during therapy for metastatic renal cell carcinoma.
DESIGN, SETTING, AND PARTICIPANTS
Retrospective analysis of 1199 patients from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC cohort) and 4350 patients from 12 prospective randomized trials (validation cohort).
INTERVENTION
Targeted therapies for metastatic renal cell carcinoma.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
NLR was examined at baseline and 6 (± 2) wk later. A landmark analysis at 8 wk was conducted to explore the prognostic value of relative NLR change on overall survival (OS), progression-free survival (PFS), and objective response rate using Cox or logistic regression models, adjusted for variables in IMDC score and NLR values at baseline.
RESULTS AND LIMITATIONS
Higher NLR at baseline was associated with shorter OS and PFS (Hazard Ratios [HR] per 1 unit increase in log-transformed NLR = 1.69 [95% confidence interval {CI} = 1.46-1.95] and 1.30 [95% CI = 1.15-1.48], respectively). Compared with no change (decrease < 25% to increase < 25%, reference), increase NLR at Week 6 by 25-50% and > 75% was associated with poor OS (HR=1.55 [95% CI=1.10-2.18] and 2.31 [95% CI=1.64-3.25], respectively), poor PFS (HR=1.46 [95% CI=1.04-2.03], 1.76 [95% CI=1.23-2.52], respectively), and reduced objective response rate (odds ratios = 0.77 [95% CI=0.37-1.63] and 0.24 [95% CI=0.08-0.72], respectively). By contrast, a decrease of 25-50% was associated with improved outcomes. Findings were confirmed in the validation cohort. The study is limited by its retrospective design.
CONCLUSIONS
Compared with no change, early decline of NLR is associated with favorable outcomes, whereas an increase is associated with worse outcomes.
PATIENT SUMMARY
We found that the proportion of immune cells in the blood is of prognostic value, namely that a decrease of the proportion of neutrophils-to-lymphocytes is associated with more favorable outcomes while an increase had the opposite effect.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.eururo.2016.02.033
- PMID 26924770
- Persistent URL
- https://folia.unifr.ch/global/documents/68604
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