Abstract
The data on the impact of the neutrophil-to-lymphocyte ratio (NLR) in metastatic renal cell carcinoma (mRCC) patients receiving tyrosine kinase inhibitors (TKIs) are inconsistent. We therefore performed a meta-analysis to assess the prognostic value of pretreatment NLR in patients treated with TKIs for mRCC. We searched the Embase, Medline, PubMed, Cochrane and ISI Web of Knowledge to identify clinical studies that had evaluated the association between the pretreatment NLR and prognosis in mRCC patients. Prognostic outcomes included overall survival (OS) and progression-free survival (PFS). Nine studies encompassing a total of 1091 participants were included. We found that a high NLR was an effective prognostic marker of both OS (pooled HR: 1.93, 95% CI: 1.35-2.77; P = 0.0003) and PFS (pooled HR: 2.12, 95% CI: 1.42-3.17; P = 0.0002). Subgroup analysis revealed that studies reporting a NLR ≥ 3 showed a more significant effect of NLR on both OS (pooled HR: 2.50, 95% CI: 1.99-3.14; P = 0.0003) and PFS (pooled HR: 2.17, 95% CI: 1.26-3.75). This meta-analysis suggests that high pretreatment NLR is associated with a poor prognosis in mRCC patients receiving TKI treatment.
Highlights
Renal cell carcinoma (RCC) is the most common cancer of the kidney
Systemic treatment of metastatic renal cell carcinoma (mRCC) has dramatically improved in recent years
Clinical trials showed that in advanced RCC, tyrosine kinase inhibitors (TKIs) such as sorafenib, sunitinib and pazopanib exert consistent therapeutic effects that prolong both overall survival (OS) and progression-free survival (PFS) [21, 22]. These targeted agents require new prognostic markers. In this meta-analysis, we detected a favorable prognosis in mRCC patients who have a low neutrophil-to-lymphocyte ratio (NLR) and use TKIs
Summary
Renal cell carcinoma (RCC) is the most common cancer of the kidney. Nearly half of RCC patients eventually develop metastatic disease (mRCC) [1, 2], and the 5-year survival rate among patients with mRCC remains poor. Tyrosine kinase inhibitors (TKIs) such as sorafenib, sunitinib, bevasizumab and pazopanib have consistently prolonged progression-free survival (PFS) and, in some cases, overall survival (OS) among patients with metastatic RCC [4]. Because these agents have provoked marked changes in the management of RCC, new predictive and prognostic clinical markers are required. The association between inflammation and cancer development has fostered an interest in the prognostic value of inflammatory factors [5, 6]. Our aim was to conduct a systematic review and metaanalysis to assess the predictive value of pre-treatment NLR in mRCC patients receiving VEGFR-TKIs
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