Princess Margaret Cancer Center, Division of Medical Oncology, Toronto, ON, Canada; Kantonsspital St. Gallen, Department of Medical Oncolgoy and Hematology, St. Gallen, Switzerland.
Princess Margaret Cancer Center, Division of Medical Oncology, Toronto, ON, Canada.
Eur Urol. 2016 Aug;70(2):358-64. doi: 10.1016/j.eururo.2016.02.033. Epub 2016 Feb 28.
Neutrophil-to-lymphocyte ratio (NLR), if elevated, is associated with worse outcomes in several malignancies.
Investigation of NLR at baseline and during therapy for metastatic renal cell carcinoma.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of 1199 patients from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC cohort) and 4350 patients from 12 prospective randomized trials (validation cohort).
Targeted therapies for metastatic renal cell carcinoma.
NLR was examined at baseline and 6 (± 2) wk later. A landmark analysis at 8 wk was conducted to explore the prognostic value of relative NLR change on overall survival (OS), progression-free survival (PFS), and objective response rate using Cox or logistic regression models, adjusted for variables in IMDC score and NLR values at baseline.
Higher NLR at baseline was associated with shorter OS and PFS (Hazard Ratios [HR] per 1 unit increase in log-transformed NLR = 1.69 [95% confidence interval {CI} = 1.46-1.95] and 1.30 [95% CI = 1.15-1.48], respectively). Compared with no change (decrease < 25% to increase < 25%, reference), increase NLR at Week 6 by 25-50% and > 75% was associated with poor OS (HR=1.55 [95% CI=1.10-2.18] and 2.31 [95% CI=1.64-3.25], respectively), poor PFS (HR=1.46 [95% CI=1.04-2.03], 1.76 [95% CI=1.23-2.52], respectively), and reduced objective response rate (odds ratios = 0.77 [95% CI=0.37-1.63] and 0.24 [95% CI=0.08-0.72], respectively). By contrast, a decrease of 25-50% was associated with improved outcomes. Findings were confirmed in the validation cohort. The study is limited by its retrospective design.
Compared with no change, early decline of NLR is associated with favorable outcomes, whereas an increase is associated with worse outcomes.
We found that the proportion of immune cells in the blood is of prognostic value, namely that a decrease of the proportion of neutrophils-to-lymphocytes is associated with more favorable outcomes while an increase had the opposite effect.
中性粒细胞与淋巴细胞比值（NLR）升高与多种恶性肿瘤的预后不良有关。
研究转移性肾细胞癌患者基线和治疗期间 NLR 的变化。
设计、地点和参与者：对国际转移性肾细胞癌数据库联盟（IMDC 队列）的 1199 例患者和 12 项前瞻性随机试验（验证队列）的 4350 例患者进行回顾性分析。
转移性肾细胞癌的靶向治疗。
在基线和 6（±2）周后检查 NLR。进行 8 周的里程碑分析，以使用 Cox 或逻辑回归模型，根据 IMDC 评分和基线 NLR 值中的变量，探索相对 NLR 变化对总生存（OS）、无进展生存（PFS）和客观缓解率的预后价值。
基线 NLR 升高与 OS 和 PFS 缩短相关（每增加 1 个单位的对数转换 NLR 的风险比[HR]分别为 1.69[95%置信区间（CI）=1.46-1.95]和 1.30[95% CI=1.15-1.48]）。与无变化（下降<25%至增加<25%，参考）相比，第 6 周 NLR 增加 25-50%和>75%与 OS 不良（HR=1.55[95% CI=1.10-2.18]和 2.31[95% CI=1.64-3.25]）、PFS 不良（HR=1.46[95% CI=1.04-2.03]，1.76[95% CI=1.23-2.52]）和客观缓解率降低（比值比=0.77[95% CI=0.37-1.63]和 0.24[95% CI=0.08-0.72]）相关。相比之下，下降 25-50%与改善的结果相关。在验证队列中也得到了证实。该研究受到其回顾性设计的限制。
与无变化相比，NLR 的早期下降与预后良好相关，而升高与预后不良相关。
我们发现血液中免疫细胞的比例具有预后价值，即中性粒细胞与淋巴细胞比例的下降与更有利的结果相关，而升高则有相反的效果。
