Additive prognostic impact of elevated De Ritis ratio and renal score in predication of survival outcomes in localized renal cell carcinoma.

Abstract

532 Background: Renal Cell Carcinoma (RCC) is a metabolically driven neoplasm. Inflammatory markers and morphometric measures have been suggested to be predictive for prognosis. We investigated the impact of a novel combination of preoperative tumor morphology (RENAL score) and a laboratory based inflammatory marker (DeRitis Ratio, AST/ALT) on survival outcomes in localized RCC. Methods: Single center, retrospective analysis of 264 patients with RCC (112 PN, 152 RN, mean follow-up 45 months) from 2003−2015. A priori, we assigned a positive marker score of “1” if RENAL >8 or DeRitis >1.5. Patients were stratified by increasing positive markers (“0”=RENAL ≤8 and DeRitis ≤1.5, “1”=RENAL >8 or DeRitis >1.5, “2”=RENAL >8 and DeRitis>1.5). Primary outcome was overall survival (OS). Cox models and Kaplan−Meier curves were utilized. Results: 264 patients, 61.7% male, mean age 64.5 ± 12.8 years, mean BMI 28.5 ± 5.6, mean AST/ALT 1.1 ± 0.4. With regards to tumor characteristics, mean clinical tumor size 4.7 ± 3.2cm and median RENAL score 9 (IQR 7−10). For clinical staging, 75.7% were cT1, 17.4% were cT2, and 6.9% were >cT2. 32.6% had 0 positive markers, 60.2% had 1 marker, and 7.2% had 2 markers. Kaplan−Meier analysis for “0”, “1”, and “2”demonstrated significantly worsened OS (log−rank p=0.03). On Cox model for OS, RENAL >8 (HR 2.13, p=0.01) or AST/ALT >1.5 (HR 2.25, p=0.028) were significantly associated with worsened survival, as was combined RENAL >8 and DeRitis > 1.5 (HR 5.1, p<0.001). Conclusions: Novel combination of a morphological score (RENAL) and an inflammatory marker (DeRitis ratio) was associated with worsened OS in localized RCC. Our findings point toward development and validation of a prognostic index to assist in risk stratification for localized RCC.