Abstract
ABSTRACTPurpose: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.
Highlights
Renal cell carcinoma (RCC), which accounts for 2-3% of adult malignancies [1], is the third most common urogenital malignancy in China
Saito et al showed that C-reactive protein (CRP) kinetics could better predict overall survival (OS) by improving the predictive accuracy by 4% compared with baseline CRP levels alone in patients with metastatic RCC (mRCC) who were treated with multimodal therapy [11]
The present study aimed to evaluate the prognostic role that CRP kinetics play in patients with mRCC who are treated with sunitinib
Summary
Renal cell carcinoma (RCC), which accounts for 2-3% of adult malignancies [1], is the third most common urogenital malignancy in China. Saito et al showed that CRP kinetics could better predict overall survival (OS) by improving the predictive accuracy by 4% compared with baseline CRP levels alone in patients with mRCC who were treated with multimodal therapy [11]. Most of this evidence was found in the era of cytokine therapy. The importance of CRP as a prognostic indicator and comparison between these models should be re-evaluated in the era of targeted therapy Based on these considerations, we previously studied patients with mRCC who were treated by sunitinib [13]. We aimed to compare models containing CRP kinetics and NLR kinetics
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