The role of the blood platelet-lymphocyte ratio, neutrophil–lymphocyte ratio and platelets in prognosis of metastatic renal cell carcinoma (mRCC).

Abstract

670 Background: Renal cell carcinoma (RCC) accounts for 2–3% of all malignant diseases in adults. In some studies, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and PLT have been demonstrated to be closely related to poor prognosis of patients with RCC. The objective of this study was to evaluate the blood platelet-lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR) and platelets (PLT) for its prognostic value in patients with metastatic renal cell cancer (mRCC). Methods: We retrospectively reviewed 141 (49 women and 92 men) patients diagnosed with mRCC previously treated with tyrosine kinase inhibitors from MSC Memorial Cancer and Institute of Oncology, Gliwice Branch in years 2006 - 2016. We assessed the prognostic value (overall survival and progression free survival) of pretreatment PLR, NLR and PLT based on univariate analysis. The cut-off value of NLR was ‘elevated’ as > 3.68 and PLR cut-off value was ‘elevated’ as > 144.4. Results: Median time of overall survival (OS) and progression free survival (PFS) were 34.1 months (from 1 to 109 months) and 8.3 months (from 0.4 to 109 months), respectively. The median PFS was shorter in NLR > 3.68 in comparison to NLR < = 3.68 (11.5 vs. 3.6 months, HR = 2.69; 95%CI, 1.76 to 4.12). Similarly, the median OS was lower in NLR > 3.68 (7.8 vs. 36.1 months, p = 0.00003; HR = 3.39; 95%CI, 2.09 to 5.50). The median PFS was shorter in PLR > 144.4 in comparison to PLR < = 144.4 (5.7 vs. 17.6 months; p = 0.00001; HR = 2.62; 95%CI, 1.76 to 3.90). Similarly, OS was worse for PLR > 144.4 (16.6 vs. 71.2 months; p = 0.00001; HR = 3.31; 95%CI, 1.98 to 5.52). Higher value of PLT ( > 400 G/l) was associated with shorter OS median (7.2 vs. 35.3 months; p = 0.001) than standard level of PLT (150-400G/l). Similarly, patients with higher neutrophil level had shorter OS (8.0 vs. 36.1 months, p = 0.0001) and PFS (3.6 vs. 11.5 months, p = 0.0001). Conclusions: Elevated pre-treatment NLR ( > 3.68) and PLR ( > 144.4) are associated with shorter OS and PFS in patients with mRCC treated with kinase inhibitors independently of other prognostic factors. Higher level of PLT ( > 400 G/l) and higher level of neutrophil ( > 6.0 x 103/ul) were also negative prognostic factors.