Abstract
Introduction: The aim of the study was to evaluate impact of the systemic immune-inflammation index (SII) on prognosis and survival within the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score groups. Methods: The records of 187 patients with metastatic renal cell carcinoma (RCC) were reviewed retrospectively. The SII was calculated as follows: SII = Neutrophil × Platelet/Lymphocyte. The patients were categorized into 2 groups based on a median SII of 730 (×109 per 1 L) as SII low (<730) and SII high (≥730). The Kaplan-Meier method was used for survival analysis and a Cox regression model was utilized to determine independent predictors of survival. Results: The median age was 61 years (range: 34–86 years). Kaplan-Meier tests revealed significant differences in survival between the SII-low and SII-high levels (27.0 vs. 12.0 months, respectively, p < 0.001). The Cox regression model revealed that SII was an independent prognostic factor. The implementation of the log-rank test in the IMDC groups according to the SII level provided the distinction of survival in the favorable group (SII low 49.0 months vs. SII high 11.0 months, p < 0.001), in the intermediate group (SII low 26.0 vs. SII high 15.0 months, p = 0.007), and in the poor group (SII low 19.0 vs. SII high 6.0 months, p = 0.019). Conclusion: The SII was an independent prognostic factor and provided significant differences in survival for the favorable, intermediate, and poor IMDC groups. Thus, the SII added to the IMDC score may be clinically beneficial in predicting survival.
References
1.
Moch
H
, Gasser
T
, Amin
MB
, Torhorst
J
, Sauter
G
, Mihatsch
MJ
. Prognostic utility of the recently recommended histologic classification and revised TNM staging system of renal cell carcinoma: a Swiss experience with 588 tumors
. Cancer
. 2000 Aug 1
;89
(3
):604
–14
. .2.
Leibovich
BC
, Lohse
CM
, Crispen
PL
, Boorjian
SA
, Thompson
RH
, Blute
ML
, et al. Histological subtype is an independent predictor of outcome for patients with renal cell carcinoma
. J Urol
. 2010 Apr
;183
(4
):1309
–15
. .3.
Lolli
C
, Basso
U
, Derosa
L
, Scarpi
E
, Sava
T
, Santoni
M
, et al. Systemic immune-inflammation index predicts the clinical outcome in patients with metastatic renal cell cancer treated with sunitinib
. Oncotarget
. 2016 Aug 23
;7
(34
):54564
–71
. .4.
Fukuda
H
, Takagi
T
, Kondo
T
, Shimizu
S
, Tanabe
K
. Predictive value of inflammation-based prognostic scores in patients with metastatic renal cell carcinoma treated with cytoreductive nephrectomy
. Oncotarget
. 2018 Mar 6
;9
(18
):14296
–305
. .5.
Ozbek
E
, Besiroglu
H
, Ozer
K
, Horsanali
MO
, Gorgel
SN
. Systemic immune inflammation index is a promising non-invasive marker for the prognosis of the patients with localized renal cell carcinoma
. Int Urol Nephrol
. 2020 Aug
;52
(8
):1455
–63
..6.
Motzer
RJ
, Bacik
J
, Murphy
BA
, Russo
P
, Mazumdar
M
. Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma
. J Clin Oncol
. 2002 Jan 1
;20
(1
):289
–96
. .7.
Ruiz-Morales
JM
, Swierkowski
M
, Wells
JC
, Fraccon
AP
, Pasini
F
, Donskov
F
, et al. First-line sunitinib versus pazopanib in metastatic renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium
. Eur J Cancer
. 2016 Sep
;65
:102
–8
. .8.
Motzer
RJ
, Tannir
NM
, McDermott
DF
, Arén Frontera
O
, Melichar
B
, Choueiri
TK
, et al. Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma
. N Engl J Med
. 2018 Apr 5
;378
(14
):1277
–90
. .9.
Chrom
P
, Zolnierek
J
, Bodnar
L
, Stec
R
, Szczylik
C
. External validation of the systemic immune-inflammation index as a prognostic factor in metastatic renal cell carcinoma and its implementation within the international metastatic renal cell carcinoma database consortium model
. Int J Clin Oncol
. 2019 May
;24
(5
):526
–32
. .10.
Negrier
S
, Escudier
B
, Gomez
F
, Douillard
JY
, Ravaud
A
, Chevreau
C
, et al. Prognostic factors of survival and rapid progression in 782 patients with metastatic renal carcinomas treated by cytokines: a report from the Groupe Francais d’Immunotherapie
. Ann Oncol
. 2002 Sep
;13
(9
):1460
–8
.11.
Hizal
M
, Sendur
MA
, Yasar
HA
, Bir Yucel
K
, Arslan
C
, Ucar
G
, et al. Neutrophil-lymphocyte ratio as a prognostic factor for survival in patients with advanced renal cell carcinoma (Turkish Oncology Group Study)
. J Oncol Pharm Pract
. 2020 Feb 13
;26
(7
):1583
. .12.
Mantovani
A
, Allavena
P
, Sica
A
, Balkwill
F
. Cancer-related inflammation
. Nature
. 2008 Jul 24
;454
(7203
):436
–44
. .13.
Kim
SH
, Kwon
WA
, Kim
S
, Joung
JY
, Seo
HK
, Lee
KH
, et al. The neutrophil-to-lymphocyte ratio makes the Heng risk model improve better the prediction of overall survival in metastatic renal cell cancer patients
. Jpn J Clin Oncol
. 2018 Sep 1
;48
(9
):835
–40
. .14.
Peng
B
, Wang
YH
, Liu
YM
, Ma
LX
. Prognostic significance of the neutrophil to lymphocyte ratio in patients with non-small cell lung cancer: a systemic review and meta-analysis
. Int J Clin Exp Med
. 2015
;8
(3
):3098
–106
..15.
Heng
DY
, Xie
W
, Regan
MM
, Warren
MA
, Golshayan
AR
, Sahi
C
, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study
. J Clin Oncol
. 2009 Dec 1
;27
(34
):5794
–9
. .16.
Tjokrowidjaja
A
, Goldstein
D
, Hudson
HM
, Lord
SJ
, Gebski
V
, Clarke
S
, et al. The impact of neutrophil-lymphocyte ratio on risk reclassification of patients with advanced renal cell cancer to guide risk-directed therapy
. Acta Oncol
. 2020 Jan
;59
(1
):20
–7
. .17.
Escudier
B
, Porta
C
, Schmidinger
M
, Rioux-Leclercq
N
, Bex
A
, Khoo
V
, et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-updagger
. Ann Oncol
. 2019 May 1
;30
(5
):706
–20
.18.
Hu
B
, Yang
XR
, Xu
Y
, Sun
YF
, Sun
C
, Guo
W
, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma
. Clin Cancer Res
. 2014 Dec 1
;20
(23
):6212
–22
. .19.
Tong
YS
, Tan
J
, Zhou
XL
, Song
YQ
, Song
YJ
. Systemic immune-inflammation index predicting chemoradiation resistance and poor outcome in patients with stage III non-small cell lung cancer
. J Transl Med
. 2017 Oct 31
;15
(1
):221
. .20.
De Giorgi
U
, Procopio
G
, Giannarelli
D
, Sabbatini
R
, Bearz
A
, Buti
S
, et al. Association of systemic inflammation index and body mass index with survival in patients with renal cell cancer treated with nivolumab
. Clin Cancer Res
. 2019 Jul 1
;25
(13
):3839
–46
. .21.
Balkwill
F
, Mantovani
A
. Inflammation and cancer: back to Virchow?
Lancet
. 2001 Feb 17
;357
(9255
):539
–45
. .22.
Song
W
, Yeh
CR
, He
D
, Wang
Y
, Xie
H
, Pang
ST
, et al. Infiltrating neutrophils promote renal cell carcinoma progression via VEGFa/HIF2α and estrogen receptor β signals
. Oncotarget
. 2015 Aug 7
;6
(22
):19290
–304
. .23.
Wojtukiewicz
MZ
, Sierko
E
, Hempel
D
, Tucker
SC
, Honn
KV
. Platelets and cancer angiogenesis nexus
. Cancer Metastasis Rev
. 2017 Jun
;36
(2
):249
–62
. .24.
Kondo
T
, Ito
F
, Nakazawa
H
, Horita
S
, Osaka
Y
, Toma
H
. High expression of chemokine gene as a favorable prognostic factor in renal cell carcinoma
. J Urol
. 2004 Jun
;171
(6 Pt 1
):2171
–5
. .25.
Chen
Y
, Yan
H
, Wang
Y
, Shi
Y
, Dai
G
. Significance of baseline and change in neutrophil-to-lymphocyte ratio in predicting prognosis: a retrospective analysis in advanced pancreatic ductal adenocarcinoma
. Sci Rep
. 2017 Apr 9
;7
(1
):753
. .26.
Saroha
S
, Uzzo
RG
, Plimack
ER
, Ruth
K
, Al-Saleem
T
. Lymphopenia is an independent predictor of inferior outcome in clear cell renal carcinoma
. J Urol
. 2013 Feb
;189
(2
):454
–61
. .27.
Fumagalli
LA
, Vinke
J
, Hoff
W
, Ypma
E
, Brivio
F
, Nespoli
A
. Lymphocyte counts independently predict overall survival in advanced cancer patients: a biomarker for IL-2 immunotherapy
. J Immunother
. 2003 Sep–Oct
;26
(5
):394
–402
. .28.
Tanaka
N
, Mizuno
R
, Yasumizu
Y
, Ito
K
, Shirotake
S
, Masunaga
A
, et al. Prognostic value of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma treated with first-line and subsequent second-line targeted therapy: a proposal of the modified-IMDC risk model
. Urol Oncol
. 2017 Feb
;35
(2
):39
–e28
. .29.
Chrom
P
, Stec
R
, Bodnar
L
, Szczylik
C
. Incorporating neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in place of neutrophil count and platelet count improves prognostic accuracy of the international metastatic renal cell carcinoma database consortium model
. Cancer Res Treat
. 2018 Jan
;50
(1
):103
–10
. .30.
Schnell
A
, Schmidl
C
, Herr
W
, Siska
PJ
. The peripheral and intratumoral immune cell landscape in cancer patients: a proxy for tumor biology and a tool for outcome prediction
. Biomedicines
. 2018 Feb 24
;6
(1
):25
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