Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Department of Urology, Medical University of Vienna, Vienna, Austria.
World J Urol. 2021 Aug;39(8):2977-2985. doi: 10.1007/s00345-021-03628-2. Epub 2021 Mar 1.
Predictive markers can help tailor treatment to the individual in metastatic renal cell carcinoma (mRCC). De Ritis ratio (DRR) is associated with oncologic outcomes in various solid tumors.
To assess the value of DRR in prognosticating survival in mRCC patients treated with tyrosine-kinase inhibitors (TKI).
Overall, 220 mRCC patients treated with TKI first-line therapy were analyzed. An optimal cut-off point for DRR was determined with Youden's J. We used multiple strata for DRR, performed descriptive, Kaplan-Meier and multivariable Cox-regression analyses to assess associations of DRR with progression-free (PFS) and overall survival (OS).
Patients above the optimal cut-off point for DRR of ≥ 1.58 had fewer liver metastases (p = 0.01). There was no difference in PFS (p > 0.05) between DRR groups. DRR above the median of 1.08 (HR 1.42; p = 0.03), DRR ≥ 1.1(HR 1.44; p = 0.02), ≥ 1.8 (HR 1.56; p = 0.03), ≥ 1.9 (HR 1.59; p = 0.02) and ≥ 2.0 (HR 1.63; p = 0.047) were associated with worse OS. These associations did not remain after multivariable adjustment. In the intermediate MSKCC group, DRR was associated with inferior OS at cut-offs ≥ 1.0 (HR 1.78; p = 0.02), ≥ 1.1 (HR 1.81; p = 0.01) and above median (HR 1.88; p = 0.007) in multivariable analyses. In patients with clear-cell histology, DRR above median (HR 1.54; p = 0.029) and DRR ≥ 1.1 (HR 1.53; p = 0.029) were associated with OS in multivariable analyses.
There was no independent association between DRR and survival of mRCC patients treated with TKI in the entire cohort. However, OS of patients with intermediate risk and clear-cell histology were affected by DRR. DRR could be used for tailored decision-making in these subgroups.
预测标志物可以帮助将治疗方法针对转移性肾细胞癌（mRCC）患者进行个体化治疗。De Ritis 比值（DRR）与各种实体瘤的肿瘤学结局相关。
评估 DRR 在接受酪氨酸激酶抑制剂（TKI）一线治疗的 mRCC 患者中的预后预测价值。
对 220 名接受 TKI 一线治疗的 mRCC 患者进行了分析。使用 Youden's J 确定 DRR 的最佳截断值。我们对 DRR 进行了多分层，进行了描述性、Kaplan-Meier 和多变量 Cox 回归分析，以评估 DRR 与无进展生存期（PFS）和总生存期（OS）的相关性。
DRR 高于≥1.58 的最佳截断值的患者肝转移较少（p=0.01）。DRR 组之间的 PFS 无差异（p>0.05）。中位值 1.08（HR 1.42；p=0.03）以上、DRR≥1.1（HR 1.44；p=0.02）、≥1.8（HR 1.56；p=0.03）、≥1.9（HR 1.59；p=0.02）和≥2.0（HR 1.63；p=0.047）与 OS 较差相关。这些相关性在多变量调整后并未持续存在。在中间 MSKCC 组中，DRR 在以下情况下与较差的 OS 相关：截断值≥1.0（HR 1.78；p=0.02）、≥1.1（HR 1.81；p=0.01）和中位数以上（HR 1.88；p=0.007）。在透明细胞组织学患者中，中位值以上的 DRR（HR 1.54；p=0.029）和 DRR≥1.1（HR 1.53；p=0.029）与多变量分析中的 OS 相关。
在整个队列中，DRR 与接受 TKI 治疗的 mRCC 患者的生存之间没有独立的相关性。然而，中危和透明细胞组织学患者的 OS 受到 DRR 的影响。DRR 可用于这些亚组的个体化决策。
