纳武单抗治疗转移性肾细胞癌患者外周血炎症比率及其细胞成分的基线和早期变化的预后价值：Δ-Meet-URO分析
The prognostic value of baseline and early variations of peripheral blood inflammatory ratios and their cellular components in patients with metastatic renal cell carcinoma treated with nivolumab: The Δ-Meet-URO analysis.
作者信息
Rebuzzi Sara Elena, Signori Alessio, Stellato Marco, Santini Daniele, Maruzzo Marco, De Giorgi Ugo, Pedrazzoli Paolo, Galli Luca, Zucali Paolo Andrea, Fantinel Emanuela, Carella Claudia, Procopio Giuseppe, Milella Michele, Boccardo Francesco, Fratino Lucia, Sabbatini Roberto, Ricotta Riccardo, Panni Stefano, Massari Francesco, Sorarù Mariella, Santoni Matteo, Cortellini Alessio, Prati Veronica, Soto Parra Hector Josè, Atzori Francesco, Di Napoli Marilena, Caffo Orazio, Messina Marco, Morelli Franco, Prati Giuseppe, Nolè Franco, Vignani Francesca, Cavo Alessia, Roviello Giandomenico, Llaja Obispo Miguel Angel, Porta Camillo, Buti Sebastiano, Fornarini Giuseppe, Banna Giuseppe Luigi
机构信息
Medical Oncology Unit, Ospedale San Paolo, Savona, Italy.
Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Genova, Italy.
出版信息
Front Oncol. 2022 Sep 23;12:955501. doi: 10.3389/fonc.2022.955501. eCollection 2022.
BACKGROUND
Treatment choice for metastatic renal cell carcinoma (mRCC) patients is still based on baseline clinical and laboratory factors.
METHODS
By a pre-specified analysis of the Meet-URO 15 multicentric retrospective study enrolling 571 pretreated mRCC patients receiving nivolumab, baseline and early dynamic variations (Δ) of neutrophil, lymphocyte, and platelet absolute cell counts (ACC) and their inflammatory ratios (IR) were evaluated alongside their association with the best disease response and overall (OS) and progression-free survival (PFS). Multivariable analyses on OS and PFS between baseline and Δ ACC and IR values were investigated with receiving operating curves-based cut-offs.
RESULTS
The analysis included 422 mRCC patients. Neutrophil-to-lymphocyte ratio (NLR) increased over time due to consistent neutrophil increase (p < 0.001). Higher baseline platelets (p = 0.044) and lower lymphocytes (p = 0.018), increasing neutrophil Δ (p for time-group interaction <0.001), higher baseline IR values (NLR: p = 0.012, SII: p = 0.003, PLR: p = 0.003), increasing NLR and systemic immune-inflammatory index (SII) (i.e., NLR x platelets) Δ (p for interaction time-group = 0.0053 and 0.0435, respectively) were associated with disease progression. OS and PFS were significantly shorter in patients with baseline lower lymphocytes (p < 0.001 for both) and higher platelets (p = 0.004 and p < 0.001, respectively) alongside early neutrophils Δ (p = 0.046 and p = 0.033, respectively). Early neutrophils and NLR Δ were independent prognostic factors for both OS (p = 0.014 and p = 0.011, respectively) and PFS (p = 0.023 and p = 0.001, respectively), alongside baseline NLR (p < 0.001 for both) and other known prognostic variables.
CONCLUSIONS
Early neutrophils and NLR Δ may represent new dynamic prognostic factors with clinical utility for on-treatment decisions.
背景
转移性肾细胞癌（mRCC）患者的治疗选择仍基于基线临床和实验室因素。
方法
通过对纳入571例接受纳武单抗治疗的经治mRCC患者的Meet-URO 15多中心回顾性研究进行预先指定的分析，评估中性粒细胞、淋巴细胞和血小板绝对细胞计数（ACC）及其炎症比率（IR）的基线和早期动态变化（Δ），以及它们与最佳疾病反应、总生存期（OS）和无进展生存期（PFS）的关联。使用基于接受操作曲线的临界值对基线与Δ ACC和IR值之间的OS和PFS进行多变量分析。
结果
分析纳入了422例mRCC患者。由于中性粒细胞持续增加，中性粒细胞与淋巴细胞比率（NLR）随时间升高（p < 0.001）。较高的基线血小板水平（p = 0.044）和较低的淋巴细胞水平（p = 0.018）、中性粒细胞Δ增加（时间-组交互作用p < 0.001）、较高的基线IR值（NLR：p = 0.012，全身免疫炎症指数（SII）：p = 0.003，血小板与淋巴细胞比率（PLR）：p = 0.003）、NLR和SII（即NLR×血小板）Δ增加（交互作用时间-组p分别为0.0053和0.0435）与疾病进展相关。基线淋巴细胞水平较低（两者p < 0.001）和血小板水平较高（分别为p = 0.004和p < 0.001）以及早期中性粒细胞Δ（分别为p = 0.046和p = 0.033）的患者，OS和PFS显著缩短。早期中性粒细胞和NLR Δ是OS（分别为p = 0.014和p = 0.011）和PFS（分别为p = 0.023和p = 0.001）的独立预后因素，同时还有基线NLR（两者p < 0.001）和其他已知的预后变量。
结论
早期中性粒细胞和NLR Δ可能代表具有临床实用性的新的动态预后因素，可用于治疗决策。
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