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. 2013 Feb;189(2):454-61.
doi: 10.1016/j.juro.2012.09.166. Epub 2012 Oct 4.

Lymphopenia is an independent predictor of inferior outcome in clear cell renal carcinoma

Sunil Saroha  1 , Robert G Uzzo, Elizabeth R Plimack, Karen Ruth, Tahseen Al-Saleem
Affiliations

Lymphopenia is an independent predictor of inferior outcome in clear cell renal carcinoma

Sunil Saroha et al. J Urol. 2013 Feb.

Abstract

Purpose: A low absolute lymphocyte count is a likely index of poor systemic immunity that may be associated with aggressive features and inferior survival in patients with clear cell renal cell carcinoma.

Materials and methods: To determine the absolute lymphocyte count we retrospectively analyzed the preoperative blood count of 430 patients with a mean age of 60 years treated with primary surgical resection at our cancer center. Absolute lymphocyte count values as a continuous variable and at a level below 1,300 cells per μl, which was our lowest reference value, were correlated with nuclear grade, pathological stage and TNM stage. We used the Kaplan-Meier method to estimate overall survival, stratified by absolute lymphocyte count status.

Results: As a continuous variable, low absolute lymphocyte count was associated with higher grade (p = 0.009), and higher pT stage (p = 0.034) and TNM stage (p <0.0001). Lymphopenia below 1,300 cells per μl was associated with high grade (p = 0.0043), pT stage (p = 0.051) and TNM stage (p <0.0001). At a median followup of 33.5 months lymphopenia was associated with inferior overall survival in a univariate model (p <0.0001), and on multivariate analysis independent of pT, N and M stages, patient age, grade, smoking history and comorbidities (p = 0.0102). Lymphopenia was also associated with inferior overall survival in a subset of young patients (age 60 years or less) with no distant metastasis (p = 0.014).

Conclusions: In 430 patients with clear cell renal cell carcinoma lymphopenia was associated with lower overall survival independent of pT and TNM stages, nuclear grade, age, tobacco smoking and comorbidity index.

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Figures

Figure 1
Figure 1
Figure 1a) Distribution of ALC, n=430 Figure 1b) Overall survival by ALC, <1.3 vs ≥ 1.3, n=424, p<0.0001 LT: Less than GE: greater/equal
Figure 2
Figure 2
Figure 2a) Overall survival by ALC, <1.3 vs ≥1.3, Stages 1–3, n=351, p=0.12 Figure 2b) Overall survival by ALC, <1.3 vs ≥1.3, Stages 1–3 and age ≤ 60,n=174, p = 0.014 Figure 2c) Overall survival by myeloid count, <5.8 vs > 5.8, n=424, p=0.41 Figure 2d) Overall survival by ratio of ALC to myeloid count, <0.3 vs ≥0.3, n=424, p = 0.003 Notes: p-values are for log rank test 0.3 is median for all those with ALC and myeloid determined
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Comment in

  • Editorial comment.
    Morgan TM. Morgan TM. J Urol. 2013 Feb;189(2):460-1. doi: 10.1016/j.juro.2012.09.183. Epub 2012 Dec 20. J Urol. 2013. PMID: 23260545 No abstract available.

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