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Prognostic Significance of Systemic Inflammatory Response in Patients with Synchronous and Metachronous Metastatic Renal Cell Carcinoma Receiving First-Line Tyrosine Kinase Inhibitors

대한비뇨기종양학회지 2019년 17권 3호 p.150 ~ 159
 ( Choi Joong-Won ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology

 ( Kim Tae-Jin ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
 ( Sung Hyun-Hwan ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
전황균 ( Jeon Hwang-Gyun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
정병창 ( Jeong Byong-Chang ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
전성수 ( Jeon Seong-Soo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
이현무 ( Lee Hyun-Moo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
최한용 ( Choi Han-Yong ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Urology
강민용 ( Kang Min-Yong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
서성일 ( Seo Seong-Il ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology

Abstract


Purpose: To determine whether systemic inflammatory response (SIR), particularly platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR), has different prognostic role between patients with metastatic renal cell carcinoma (mRCC) receiving first-line tyrosine kinase inhibitors (TKI).

Materials and Methods: We retrospectively reviewed 547 patients with mRCC who were diagnosed and treated with a first-line TKI between 2007 and 2015. The primary endpoint was overall survival (OS) and secondary endpoint was progression-free survival (PFS). We evaluated differences in survival outcomes according to SIR and identified predictors of OS and PFS.

Results: In synchronous mRCC, patients with a higher PLR had significantly worse OS and PFS. Moreover, a higher NLR was also associated with both worse OS and PFS in these patients. However, PLR was not associated with either OS or PFS in metachronous mRCC patients. While metachronous mRCC patients with a higher NLR had worse OS compared to those with lower NLR, there was no difference in PFS according to the status of NLR. On multivariate analysis, PLR was identified as predictive factor for OS (hazard ratio [HR], 1.55) as well as PFS (HR, 1.39) in patients with synchronous mRCC, but not in patients with metachronous mRCC. Additionally, higher NLR was also remained as predictive factor of both OS (HR, 1.83) and PFS (HR, 1.57) in patients with synchronous mRCC.

Conclusions: Our study indicates that simple biomarkers of SIR, particularly PLR and NLR, can be more useful predictors of survival outcomes in patients with synchronous mRCC rather than metachronous mRCC.

키워드

Metastatic renal cell carcinoma; Metachronous; Prognosticator; Synchronous; Systemic inflammatory response; Tyrosine kinase inhibitor
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