Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
Department of Medicine, Internal Medicine Residency Program, Emory University, Atlanta, GA.
Clin Genitourin Cancer. 2018 Jun;16(3):e563-e575. doi: 10.1016/j.clgc.2017.12.015. Epub 2018 Jan 4.
Biomarkers to guide treatment in metastatic renal-cell carcinoma (mRCC) are lacking. We aimed to investigate the association between pretreatment neutrophil-to-lymphocyte ratio (NLR) and outcome of patients with mRCC receiving nivolumab.
Through retrospective chart review, we identified 38 patients with mRCC treated with standard-of-care nivolumab between 2015 and 2016 at Winship Cancer Institute of Emory University. NLR was determined from complete blood count collected before starting treatment, and imaging was performed to assess progression. The NLR cutoff value of 5.5 was determined by log-rank test, and the univariate association with overall survival (OS) or progression-free survival (PFS) was assessed by the Cox proportional hazard model and Kaplan-Meier method.
The 38 patients had a median age of 69 years. The PFS and OS for all patients at 12 months was 54% and 69%, respectively. The median PFS was 2.6 months in the high NLR group but not reached in the low NLR group. Low NLR was strongly associated with increased PFS with hazard ratio of 0.20 (95% confidence interval, 0.07-0.64; P = .006). The median OS was 2.7 months in the high NLR group but not reached in the low NLR group. Low NLR was significantly associated with a prolonged OS with hazard ratio of 0.06 (95% confidence interval, 0.01-0.55; P = .012).
Pretreatment NLR < 5.5 is associated with superior PFS and OS. NLR is a biomarker that can inform prognosis for patients with mRCC and should be further validated in larger cohorts and in prospective studies.
转移性肾细胞癌（mRCC）缺乏指导治疗的生物标志物。我们旨在研究接受纳武利尤单抗治疗的 mRCC 患者治疗前中性粒细胞与淋巴细胞比值（NLR）与结局之间的关系。
通过回顾性病历审查，我们确定了 2015 年至 2016 年在埃默里大学温希普癌症研究所接受标准 care 纳武利尤单抗治疗的 38 例 mRCC 患者。在开始治疗前采集全血细胞计数来确定 NLR，通过影像学评估进展情况。通过对数秩检验确定 NLR 截断值为 5.5，通过 Cox 比例风险模型和 Kaplan-Meier 方法评估与总生存期（OS）或无进展生存期（PFS）的单变量相关性。
38 例患者的中位年龄为 69 岁。所有患者的 12 个月 PFS 和 OS 分别为 54%和 69%。高 NLR 组的中位 PFS 为 2.6 个月，而低 NLR 组未达到。低 NLR 与 PFS 延长显著相关，风险比为 0.20（95%置信区间，0.07-0.64；P =.006）。高 NLR 组的中位 OS 为 2.7 个月，而低 NLR 组未达到。低 NLR 与 OS 延长显著相关，风险比为 0.06（95%置信区间，0.01-0.55；P =.012）。
治疗前 NLR < 5.5 与 PFS 和 OS 改善相关。NLR 是一种可用于预测 mRCC 患者预后的生物标志物，应在更大的队列和前瞻性研究中进一步验证。
