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Comprehensive analysis and validation of contemporary survival prognosticators in Korean patients with metastatic renal cell carcinoma treated with targeted therapy: prognostic impact of pretreatment neutrophil-to-lymphocyte ratio.

Authors
 Kyo Chul Koo  ;  Kwang Suk Lee  ;  Kang Su Cho  ;  Koon Ho Rha  ;  Sung Joon Hong  ;  Byung Ha Chung 
Citation
 International Urology and Nephrology, Vol.48(6) : 985-992, 2016 
Journal Title
 International Urology and Nephrology 
ISSN
 0301-1623 
Issue Date
2016
MeSH
Asian Continental Ancestry Group* ; Carcinoma, Renal Cell/mortality* ; Carcinoma, Renal Cell/secondary* ; Carcinoma, Renal Cell/therapy ; Cohort Studies ; Female ; Humans ; Kidney Neoplasms/mortality* ; Kidney Neoplasms/pathology* ; Kidney Neoplasms/therapy ; Lymphocyte Count ; Lymphocytes ; Male ; Molecular Targeted Therapy* ; Neutrophils ; Prognosis ; Republic of Korea ; Survival Rate
Keywords
Nephrectomy ; Prognostic factors ; Renal cell carcinoma
Abstract
PURPOSE: In line with the era of targeted therapy (TT), an increasing number of prognosticators are becoming available for patients with metastatic renal cell carcinoma (mRCC). Here, potential prognosticators of cancer-specific survival (CSS) were identified based on the contemporary literature and were comprehensively validated in an independent cohort of patients treated for mRCC. METHODS: Data were collected from 478 patients treated with TT for mRCC between January 1999 and July 2013 at a single institution. The analysis included 25 clinicopathological covariates that included both traditional and contemporary prognosticators. Multivariate Cox regression models were used to quantify the effect of covariates on CSS. RESULTS: Median survival from the initial diagnosis of metastasis was 24.5 (IQR, 11.5-55.7) months. There were 303 (63.4 %) cancer-specific deaths, yielding a 2-year CSS rate of 62.5 %. Low Karnofsky performance status (KPS), hypercalcemia, neutrophil-to-lymphocyte ratio (NLR), the number of metastatic sites (≥2), and the presence of brain metastases were independent adverse prognosticators of CSS. The C-index of the model was 0.78. Patients with at least one adverse prognosticator demonstrated lower 2-year CSS rates compared to those with no prognosticators (53.9 vs. 70.6 %; log rank p < 0.001). CONCLUSIONS: Together with traditional prognosticators such as KPS, hypercalcemia, and the number and location of metastases, the NLR was an independent predictor of CSS in patients with mRCC treated with TT. Our findings could be useful for guiding clinical decision making including stratification of patients for TT and inclusion in clinical trials.
Full Text
http://link.springer.com/article/10.1007/s11255-016-1252-9
DOI
10.1007/s11255-016-1252-9
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
구교철(Koo, Kyo Chul) ORCID logo https://orcid.org/0000-0001-7303-6256
나군호(Rha, Koon Ho) ORCID logo https://orcid.org/0000-0001-8588-7584
이광석(Lee, Kwang Suk) ORCID logo https://orcid.org/0000-0002-7961-8393
정병하(Chung, Byung Ha) ORCID logo https://orcid.org/0000-0001-9817-3660
조강수(Cho, Kang Su) ORCID logo https://orcid.org/0000-0002-3500-8833
홍성준(Hong, Sung Joon) ORCID logo https://orcid.org/0000-0001-9869-065X
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/147069
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