Rebuzzi Sara Elena, Cerbone Luigi, Signori Alessio, Santoni Matteo, Murianni Veronica, De Giorgi Ugo, Procopio Giuseppe, Porta Camillo, Milella Michele, Basso Umberto, Massari Francesco, Maruzzo Marco, Iacovelli Roberto, Battelli Nicola, Carmisciano Luca, Banna Giuseppe Luigi, Buti Sebastiano, Fornarini Giuseppe
Medical Oncology Unit, Ospedale San Paolo, Via Genova, 30, 17100 Savona, Italy.
Inserm U981, Villejuif, France.
Ther Adv Med Oncol. 2022 Feb 26;14:17588359221079580. doi: 10.1177/17588359221079580. eCollection 2022.
The addition of neutrophil-to-lymphocyte ratio (NLR) and bone metastases to the International Metastatic RCC Database Consortium (IMDC) score (by the Meet-URO score) has been shown to better stratify pretreated metastatic renal cell carcinoma (mRCC) patients receiving nivolumab. This study aimed to validate the Meet-URO score in patients receiving cabozantinib to assess its predictivity and prognostic role.
A multicenter retrospective analysis evaluated mRCC patients receiving ⩾second-line cabozantinib. NLR, IMDC score and bone metastases were assessed before the start of cabozantinib. The primary endpoint was overall survival (OS). Harrell's -index was calculated to compare the accuracy of the prediction of the two scores.
Overall, 174 mRCC patients received cabozantinib as second and third line (51.7% and 48.3%, respectively) with a median follow-up of 6.8 months. A shorter median overall survival (mOS) was observed for the IMDC poor-risk group, NLR ⩾3.2 and the presence of bone metastases, while the IMDC intermediate-risk group had a similar mOS to the favourable-risk one. Applying the Meet-URO score, three risk groups were identified: group 1 (55.2% of patients) with a score of 0-3, group 2 (38.5%) with a score of 4-8 and group 3 (6.3%) with a score of 9. Compared to group 1 (mOS: 39.4 months), a statistically significant worse mOS was observed in group 2 (11.2 months) and group 3 (3.2 months) patients, respectively. The Meet-URO -index score was 0.640, showing a higher discriminative ability than the IMDC score (-index: 0.568).
This analysis showed that the Meet-URO score provides a more accurate prognostic stratification than the IMDC score in mRCC patients treated with ⩾second-line cabozantinib besides nivolumab. Moreover, it is an easy-to-use tool with no additional costs for clinical practice (web-calculator is available at: https://proviso.shinyapps.io/Meet-URO15_score/). Future investigations will include the application of the Meet-URO score to the first-line immunotherapy-based combination therapies.
国际转移性肾细胞癌数据库联盟（IMDC）评分（通过Meet-URO评分）加入中性粒细胞与淋巴细胞比值（NLR）和骨转移情况，已被证明能更好地对接受纳武单抗治疗的经治转移性肾细胞癌（mRCC）患者进行分层。本研究旨在验证Meet-URO评分在接受卡博替尼治疗的患者中的有效性，以评估其预测性和预后作用。
一项多中心回顾性分析评估了接受≥二线卡博替尼治疗的mRCC患者。在开始使用卡博替尼之前评估NLR、IMDC评分和骨转移情况。主要终点为总生存期（OS）。计算Harrell's C指数以比较两种评分预测的准确性。
总体而言，174例mRCC患者接受卡博替尼作为二线和三线治疗（分别为51.7%和48.3%），中位随访时间为6.月。IMDC低危组、NLR≥3.2以及存在骨转移的患者观察到较短的中位总生存期（mOS），而IMDC中危组的mOS与高危组相似。应用Meet-URO评分，确定了三个风险组：第1组（占患者的55.2%）评分为0 - 3分，第2组（38.5%）评分为4 - 8分，第3组（6.3%）评分为9分。与第1组（mOS：39.4个月）相比，第2组（11.2个月）和第3组（3.2个月）患者的mOS在统计学上显著更差。Meet-URO C指数评分为0.640，显示出比IMDC评分（C指数：0.568）更高的判别能力。
该分析表明，在接受≥二线卡博替尼治疗的mRCC患者中，除纳武单抗外，Meet-URO评分比IMDC评分提供了更准确的预后分层。此外，它是一种易于使用的工具且在临床实践中无需额外费用（可通过以下网址使用网络计算器：https://proviso.shinyapps.io/Meet-URO15_score/）。未来的研究将包括将Meet-URO评分应用于基于一线免疫治疗的联合疗法。
