Prognostic significance of the dynamic changes of systemic inflammatory response in metastatic renal cell carcinoma

Abstract

Purpose: To elucidate the prognostic value of systemic inflammatory response in patients with metastatic renal cell carcinoma (mRCC) who are treated with sunitinib, we evaluated the prognostic role of C-reactive protein (CRP) kinetics. This study also compared prognostic models containing CRP kinetics and neutrophil-to-lymphocyte ratio (NLR) kinetics.

Materials and methods: A consecutive cohort of 94 patients with mRCC who were treated with sunitinib was retrospectively included from Fudan University Shanghai Cancer Center. According to dynamic changes in CRP and the NLR, patients were divided into three groups for analysis of CRP and NLR kinetics. The associations between survival and potential prognostic factors were assessed. The incremental value of prognostication was evaluated.

Results: A significant difference (P<0.001) in overall survival (OS) was observed among the three groups of CRP kinetics. The median OS of the non-elevated group was nearly 1.3-fold longer than that of the normalized group (33.0 vs. 26.3 months), and two times longer than that of the non-normalized group (33.0 vs. 14.0 months). Multivariate analysis showed that CRP and NLR kinetics were independent prognostic indicators. The model containing CRP kinetics had a better predictive accuracy than that with NLR kinetics, which was supported by the C-index (0.731 vs. 0.684) and the likelihood ratio χ² test (79.9% vs. 44.9%).

Conclusion: Our study suggests that dynamic changes in CRP can better predict survival in patients with mRCC who are treated with sunitinib. Routine assessment of CRP before and after targeted therapy would help identify patients at risk of a poor outcome.

Keywords: Carcinoma, Renal Cell; Molecular Targeted Therapy; Prognosis.

Figure 1. Overall survival (OS) and progression-free survival (PFS) analysis of patients with metastatic renal cell carcinoma based on CRP and NLR kinetics. Kaplan-Meier analysis of OS for CRP kinetics (A) and NLR kinetics (B), and PFS for CRP kinetics (C) and NLR kinetics (D).

Figure 2. The likelihood ratio χ² test showing the adequacy index for different prognostic models. The columns, from left to right, show the adequacy indices for MSKCC, MSKCC+CRP kinetics, MSKCC+NLR kinetics, and MSKCC+CRP kinetics+CRP kinetics.