Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Medical Oncology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
Intern Med J. 2016 Nov;46(11):1291-1297. doi: 10.1111/imj.13202.
The role of cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) in the era of targeted therapies is currently undefined. In recent years, neutrophil-to-lymphocyte ratio (NLR) has emerged as a prognostic marker in several cancers, including mRCC. In this multicentre retrospective study, we aim to assess the impact of CN in mRCC and the value of NLR in risk stratification and patient selection.
Retrospective data from patients with de novo mRCC from four large Australian hospitals were collected. Survival analyses were performed using the Kaplan-Meier method and compared using the log-rank test. Multivariate analyses were performed using the Cox proportional hazards method.
Our study identified 91 de novo mRCC patients. Patients who underwent CN (n = 46, 51%) were more likely to be younger (59.0 years vs 64.6 years, P = 0.019) and to have received systemic therapy (91% vs 76%, P = 0.043). Median overall survival (mOS) was significantly improved in patients who underwent CN (23.0 months vs 10.9 months, hazard ratios (HR) 0.33, 95% confidence interval (CI) 0.20-0.55, P < 0.0001). Patients with NLR ≥ 5 also had inferior mOS (6.2 months vs 16.7 months, HR 1.94, 95% CI 1.14-3.29, P = 0.014). CN was associated with substantially improved survival in patients with both NLR < 5 (mOS 31.1 months vs 7.0 months, HR 0.41, 95% CI, 0.18-0.64, P = 0.0009) and NLR ≥ 5 (mOS 10.9 months vs 2.3 months, HR 0.33, 95% CI, 0.11-0.69, P = 0.009). Significant survival benefits associated with CN were maintained in multivariate analyses (HR 0.39, 95% CI 0.22-0.70, P = 0.0014).
CN is associated with significantly improved overall survival in de novo mRCC. The incremental survival benefit associated with CN was seen irrespective of NLR.
在靶向治疗时代，细胞减积性肾切除术（CN）在转移性肾细胞癌（mRCC）中的作用目前尚未明确。近年来，中性粒细胞与淋巴细胞比值（NLR）已成为包括 mRCC 在内的多种癌症的预后标志物。在这项多中心回顾性研究中，我们旨在评估 CN 在 mRCC 中的作用以及 NLR 在风险分层和患者选择中的价值。
从澳大利亚四家大型医院的初发 mRCC 患者中收集回顾性数据。使用 Kaplan-Meier 方法进行生存分析，并使用对数秩检验进行比较。使用 Cox 比例风险方法进行多变量分析。
我们的研究确定了 91 例初发 mRCC 患者。接受 CN（n=46，51%）的患者更年轻（59.0 岁 vs 64.6 岁，P=0.019），且更有可能接受系统治疗（91% vs 76%，P=0.043）。接受 CN 的患者中位总生存期（mOS）明显改善（23.0 个月 vs 10.9 个月，风险比（HR）0.33，95%置信区间（CI）0.20-0.55，P<0.0001）。NLR≥5 的患者 mOS 也较差（6.2 个月 vs 16.7 个月，HR 1.94，95% CI 1.14-3.29，P=0.014）。CN 与 NLR<5（mOS 31.1 个月 vs 7.0 个月，HR 0.41，95% CI，0.18-0.64，P=0.0009）和 NLR≥5（mOS 10.9 个月 vs 2.3 个月，HR 0.33，95% CI，0.11-0.69，P=0.009）患者的生存显著改善相关。CN 与生存获益的相关性在多变量分析中仍然显著（HR 0.39，95% CI 0.22-0.70，P=0.0014）。
CN 与初发 mRCC 的总生存显著改善相关。CN 相关的生存获益与 NLR 无关。
