Prognostic significance of the dynamic changes of systemic inflammatory response in metastatic renal cell carcinoma

Vol. 44 (x): 2018 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0500


ORIGINAL ARTICLE

Beihe Wang 1, 2, Weijie Gu 1, 2, Fangning Wan 1, 2, Guohai Shi 1, 2, Dingwei Ye 1, 2
1 Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

 

ABSTRACT  

Purpose: To elucidate the prognostic value of systemic inflammatory response in pa­tients with metastatic renal cell carcinoma (mRCC) who are treated with sunitinib, we evaluated the prognostic role of C-reactive protein (CRP) kinetics. This study also compared prognostic models containing CRP kinetics and neutrophil-to-lymphocyte ratio (NLR) kinetics.

Materials and Methods: A consecutive cohort of 94 patients with mRCC who were treated with sunitinib was retrospectively included from Fudan University Shanghai Cancer Center. According to dynamic changes in CRP and the NLR, patients were divided into three groups for analysis of CRP and NLR kinetics. The associations between survival and potential prognostic factors were assessed. The incremental value of prognostication was evaluated.

Results: A significant difference (P<0.001) in overall survival (OS) was observed among the three groups of CRP kinetics. The median OS of the non-elevated group was nearly 1.3-fold longer than that of the normalized group (33.0 vs. 26.3 months), and two times longer than that of the non-normalized group (33.0 vs. 14.0 months). Multivari­ate analysis showed that CRP and NLR kinetics were independent prognostic indica­tors. The model containing CRP kinetics had a better predictive accuracy than that with NLR kinetics, which was supported by the C-index (0.731 vs. 0.684) and the likelihood ratio χ² test (79.9% vs. 44.9%).

Conclusion: Our study suggests that dynamic changes in CRP can better predict surviv­al in patients with mRCC who are treated with sunitinib. Routine assessment of CRP be­fore and after targeted therapy would help identify patients at risk of a poor outcome.

Keywords:  Carcinoma, Renal Cell; Molecular Targeted Therapy; Prognosis

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