Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma

D. Day, Y. Kanjanapan, E. Kwan, D. Yip, N. Lawrentschuk, I. D. Davis, A. A. Azad, S. Wong, M. Rosenthal, P. Gibbs, B. Tran

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The role of cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) in the era of targeted therapies is currently undefined. In recent years, neutrophil-to-lymphocyte ratio (NLR) has emerged as a prognostic marker in several cancers, including mRCC. In this multicentre retrospective study, we aim to assess the impact of CN in mRCC and the value of NLR in risk stratification and patient selection. Methods: Retrospective data from patients with de novo mRCC from four large Australian hospitals were collected. Survival analyses were performed using the Kaplan–Meier method and compared using the log-rank test. Multivariate analyses were performed using the Cox proportional hazards method. Results: Our study identified 91 de novo mRCC patients. Patients who underwent CN (n = 46, 51%) were more likely to be younger (59.0 years vs 64.6 years, P = 0.019) and to have received systemic therapy (91% vs 76%, P = 0.043). Median overall survival (mOS) was significantly improved in patients who underwent CN (23.0 months vs 10.9 months, hazard ratios (HR) 0.33, 95% confidence interval (CI) 0.20–0.55, P < 0.0001). Patients with NLR ≥ 5 also had inferior mOS (6.2 months vs 16.7 months, HR 1.94, 95% CI 1.14–3.29, P = 0.014). CN was associated with substantially improved survival in patients with both NLR < 5 (mOS 31.1 months vs 7.0 months, HR 0.41, 95% CI, 0.18–0.64, P = 0.0009) and NLR ≥ 5 (mOS 10.9 months vs 2.3 months, HR 0.33, 95% CI, 0.11–0.69, P = 0.009). Significant survival benefits associated with CN were maintained in multivariate analyses (HR 0.39, 95% CI 0.22–0.70, P = 0.0014). Conclusions: CN is associated with significantly improved overall survival in de novo mRCC. The incremental survival benefit associated with CN was seen irrespective of NLR.

Original languageEnglish
Pages (from-to)1291-1297
Number of pages7
JournalInternal Medicine Journal
Volume46
Issue number11
DOIs
Publication statusPublished - 1 Nov 2016

Keywords

  • cytoreductive nephrectomy
  • neutrophil-to-lymphocyte ratio
  • renal cell carcinoma

Cite this

Day, D. ; Kanjanapan, Y. ; Kwan, E. ; Yip, D. ; Lawrentschuk, N. ; Davis, I. D. ; Azad, A. A. ; Wong, S. ; Rosenthal, M. ; Gibbs, P. ; Tran, B. / Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma. In: Internal Medicine Journal. 2016 ; Vol. 46, No. 11. pp. 1291-1297.
@article{5d5fe47c0467491290f47712eb11f48a,
title = "Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma",
abstract = "Background: The role of cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) in the era of targeted therapies is currently undefined. In recent years, neutrophil-to-lymphocyte ratio (NLR) has emerged as a prognostic marker in several cancers, including mRCC. In this multicentre retrospective study, we aim to assess the impact of CN in mRCC and the value of NLR in risk stratification and patient selection. Methods: Retrospective data from patients with de novo mRCC from four large Australian hospitals were collected. Survival analyses were performed using the Kaplan–Meier method and compared using the log-rank test. Multivariate analyses were performed using the Cox proportional hazards method. Results: Our study identified 91 de novo mRCC patients. Patients who underwent CN (n = 46, 51{\%}) were more likely to be younger (59.0 years vs 64.6 years, P = 0.019) and to have received systemic therapy (91{\%} vs 76{\%}, P = 0.043). Median overall survival (mOS) was significantly improved in patients who underwent CN (23.0 months vs 10.9 months, hazard ratios (HR) 0.33, 95{\%} confidence interval (CI) 0.20–0.55, P < 0.0001). Patients with NLR ≥ 5 also had inferior mOS (6.2 months vs 16.7 months, HR 1.94, 95{\%} CI 1.14–3.29, P = 0.014). CN was associated with substantially improved survival in patients with both NLR < 5 (mOS 31.1 months vs 7.0 months, HR 0.41, 95{\%} CI, 0.18–0.64, P = 0.0009) and NLR ≥ 5 (mOS 10.9 months vs 2.3 months, HR 0.33, 95{\%} CI, 0.11–0.69, P = 0.009). Significant survival benefits associated with CN were maintained in multivariate analyses (HR 0.39, 95{\%} CI 0.22–0.70, P = 0.0014). Conclusions: CN is associated with significantly improved overall survival in de novo mRCC. The incremental survival benefit associated with CN was seen irrespective of NLR.",
keywords = "cytoreductive nephrectomy, neutrophil-to-lymphocyte ratio, renal cell carcinoma",
author = "D. Day and Y. Kanjanapan and E. Kwan and D. Yip and N. Lawrentschuk and Davis, {I. D.} and Azad, {A. A.} and S. Wong and M. Rosenthal and P. Gibbs and B. Tran",
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Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma. / Day, D.; Kanjanapan, Y.; Kwan, E.; Yip, D.; Lawrentschuk, N.; Davis, I. D.; Azad, A. A.; Wong, S.; Rosenthal, M.; Gibbs, P.; Tran, B.

In: Internal Medicine Journal, Vol. 46, No. 11, 01.11.2016, p. 1291-1297.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma

AU - Day, D.

AU - Kanjanapan, Y.

AU - Kwan, E.

AU - Yip, D.

AU - Lawrentschuk, N.

AU - Davis, I. D.

AU - Azad, A. A.

AU - Wong, S.

AU - Rosenthal, M.

AU - Gibbs, P.

AU - Tran, B.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background: The role of cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) in the era of targeted therapies is currently undefined. In recent years, neutrophil-to-lymphocyte ratio (NLR) has emerged as a prognostic marker in several cancers, including mRCC. In this multicentre retrospective study, we aim to assess the impact of CN in mRCC and the value of NLR in risk stratification and patient selection. Methods: Retrospective data from patients with de novo mRCC from four large Australian hospitals were collected. Survival analyses were performed using the Kaplan–Meier method and compared using the log-rank test. Multivariate analyses were performed using the Cox proportional hazards method. Results: Our study identified 91 de novo mRCC patients. Patients who underwent CN (n = 46, 51%) were more likely to be younger (59.0 years vs 64.6 years, P = 0.019) and to have received systemic therapy (91% vs 76%, P = 0.043). Median overall survival (mOS) was significantly improved in patients who underwent CN (23.0 months vs 10.9 months, hazard ratios (HR) 0.33, 95% confidence interval (CI) 0.20–0.55, P < 0.0001). Patients with NLR ≥ 5 also had inferior mOS (6.2 months vs 16.7 months, HR 1.94, 95% CI 1.14–3.29, P = 0.014). CN was associated with substantially improved survival in patients with both NLR < 5 (mOS 31.1 months vs 7.0 months, HR 0.41, 95% CI, 0.18–0.64, P = 0.0009) and NLR ≥ 5 (mOS 10.9 months vs 2.3 months, HR 0.33, 95% CI, 0.11–0.69, P = 0.009). Significant survival benefits associated with CN were maintained in multivariate analyses (HR 0.39, 95% CI 0.22–0.70, P = 0.0014). Conclusions: CN is associated with significantly improved overall survival in de novo mRCC. The incremental survival benefit associated with CN was seen irrespective of NLR.

AB - Background: The role of cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) in the era of targeted therapies is currently undefined. In recent years, neutrophil-to-lymphocyte ratio (NLR) has emerged as a prognostic marker in several cancers, including mRCC. In this multicentre retrospective study, we aim to assess the impact of CN in mRCC and the value of NLR in risk stratification and patient selection. Methods: Retrospective data from patients with de novo mRCC from four large Australian hospitals were collected. Survival analyses were performed using the Kaplan–Meier method and compared using the log-rank test. Multivariate analyses were performed using the Cox proportional hazards method. Results: Our study identified 91 de novo mRCC patients. Patients who underwent CN (n = 46, 51%) were more likely to be younger (59.0 years vs 64.6 years, P = 0.019) and to have received systemic therapy (91% vs 76%, P = 0.043). Median overall survival (mOS) was significantly improved in patients who underwent CN (23.0 months vs 10.9 months, hazard ratios (HR) 0.33, 95% confidence interval (CI) 0.20–0.55, P < 0.0001). Patients with NLR ≥ 5 also had inferior mOS (6.2 months vs 16.7 months, HR 1.94, 95% CI 1.14–3.29, P = 0.014). CN was associated with substantially improved survival in patients with both NLR < 5 (mOS 31.1 months vs 7.0 months, HR 0.41, 95% CI, 0.18–0.64, P = 0.0009) and NLR ≥ 5 (mOS 10.9 months vs 2.3 months, HR 0.33, 95% CI, 0.11–0.69, P = 0.009). Significant survival benefits associated with CN were maintained in multivariate analyses (HR 0.39, 95% CI 0.22–0.70, P = 0.0014). Conclusions: CN is associated with significantly improved overall survival in de novo mRCC. The incremental survival benefit associated with CN was seen irrespective of NLR.

KW - cytoreductive nephrectomy

KW - neutrophil-to-lymphocyte ratio

KW - renal cell carcinoma

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U2 - 10.1111/imj.13202

DO - 10.1111/imj.13202

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JF - Internal Medicine Journal

SN - 1444-0903

IS - 11

ER -