Samar Mirza Rameez, Javaid Maha, Zehra Nida E, Zehra Nawazish, Hameed Muhammad Arif, Soomro Misbah Younus, Ali Insia, Rashid Yasmin Abdul
Medical Oncology, Department of Oncology, The Aga Khan University, Karachi 74600, Pakistan.
Department of Oncology, The Aga Khan University, Karachi 74600, Pakistan.
Ecancermedicalscience. 2024 Sep 3;18:1753. doi: 10.3332/ecancer.2024.1753. eCollection 2024.
Renal cell carcinomas (RCCs) are renal parenchymal neoplasms that contribute to <5% of cancer cases worldwide. Within the diverse group of renal tumours, clear cell carcinoma is the most common subtype. The recommended first-line treatment for metastatic disease is a tyrosine kinase inhibitor given either as monotherapy or in combination with an immune checkpoint inhibitor, based on improved survival outcomes. These endpoints are not only influenced by the initial risk stratification but also by certain variables such as the neutrophil-to-lymphocyte (NLR) ratio.
A retrospective review was conducted to evaluate the progression-free survival (PFS) with first-line treatment in patients with metastatic RCC treated at our institute from the year 2017-2021. We also investigated the association of PFS with both Memorial Sloan Kettering Cancer Center risk groups and the pretreatment NLR ratio.
Overall, 35 patients were enrolled after fulfilling the eligibility criteria. Of these, 25 patients received Pazopanib, 5 patients were treated with Sunitinib and the remaining patients were administered Pembrolizumab with Axitinib. Two-thirds of the study population belonged to the intermediate-risk group. The median PFS for all participants was 16 months. Among the overall population, patients in the favourable-risk group demonstrated superior PFS. Patients with elevated pretreatment NLR experienced shorter PFS compared to the patients with low to normal NLR.
This review highlights the prognostic significance of initial risk stratification and pretreatment NLR in predicting the response to first-line treatment in metastatic RCC patients. As this is a comprehensive study emphasizing the outcomes of metastatic RCC in Pakistan, it fills a void in the literature by providing invaluable perspectives on the real-world outcomes of patients. This not only enhances our understanding of disease management in this region but also lays the foundation for future investigations.
肾细胞癌（RCC）是肾实质肿瘤，在全球癌症病例中占比不到5%。在各种肾肿瘤中，透明细胞癌是最常见的亚型。基于生存结果的改善，转移性疾病的推荐一线治疗是酪氨酸激酶抑制剂，可单药治疗或与免疫检查点抑制剂联合使用。这些终点不仅受初始风险分层的影响，还受某些变量的影响，如中性粒细胞与淋巴细胞（NLR）比值。
进行了一项回顾性研究，以评估2017年至2021年在我院接受治疗的转移性RCC患者一线治疗的无进展生存期（PFS）。我们还研究了PFS与纪念斯隆凯特琳癌症中心风险组和治疗前NLR比值之间的关联。
总体而言，35名患者符合入选标准后入组。其中，25名患者接受帕唑帕尼治疗，5名患者接受舒尼替尼治疗，其余患者接受派姆单抗联合阿昔替尼治疗。三分之二的研究人群属于中危组。所有参与者的中位PFS为16个月。在总体人群中，低危组患者的PFS更佳。与NLR低至正常的患者相比，治疗前NLR升高的患者PFS较短。
本综述强调了初始风险分层和治疗前NLR在预测转移性RCC患者一线治疗反应中的预后意义。由于这是一项强调巴基斯坦转移性RCC结局的综合研究，它通过提供关于患者真实世界结局的宝贵观点填补了文献空白。这不仅增强了我们对该地区疾病管理的理解，也为未来的研究奠定了基础。
