Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor of Disease-free Survival in Postnephrectomy High-risk Locoregional Renal Cell Carcinoma: Analysis of the S-TRAC Trial

Patel, Anup; Ravaud, Alain; Motzer, Robert J.; Pantuck, Allan J.; Staehler, Michael; Escudier, Bernard; Martini, Jean-Francois; Lechuga, Mariajose; Lin, Xun und George, Daniel J. (2020): Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor of Disease-free Survival in Postnephrectomy High-risk Locoregional Renal Cell Carcinoma: Analysis of the S-TRAC Trial. In: Clinical Cancer Research, Bd. 26, Nr. 18: S. 4863-4868

Abstract

Purpose: In the S-TRAC trial, adjuvant sunitinib improved disease-free survival (DFS) compared with placebo in patients with locoregional renal cell carcinoma (RCC) at high risk of recurrence. This post hoc exploratory analysis investigated the neutrophil-to-lymphocyte ratio (NLR) for predictive and prognostic significance in the RCC adjuvant setting. Experimental Design: Kaplan-Meier estimates and Cox proportional analyses were performed on baseline NLR and change from baseline at week 4 to assess their association with DFS. Univariate P values were two-sided and based on an unstratified log-rank test. Results: 609 of 615 patients had baseline NLR values;574 patients had baseline and week 4 values. Sunitinib-treated patients with baseline NLR <3 had longer DFS versus placebo (7.1 vs. 4.7;HR, 0.71;P = 0.02). For baseline NLR >= 3, DFS was similar regardless of treatment (sunitinib 6.8 vs. placebo not reached;HR, 1.03;P = 0.91). A >= 25% NLR decrease at week 4 was associated with longer DFS versus no change (6.8 vs. 5.3 years;HR, 0.71;P = 0.01). A greater proportion of sunitinib-treated patients had >= 25% NLR decrease at week 4 (71.2%) versus placebo (17.4%). Patients with >= 25% NLR decrease at week 4 received a higher median cumulative sunitinib dose (10,137.5 mg) versus no change (8,168.8 mg) or >= 25% increase (6,712.5 mg). Conclusions: In the postnephrectomy high-risk RCC patient cohort, low baseline NLR may help identify those most suitable for adjuvant sunitinib. A >= 25% NLR decrease at week 4 may be an early indicator of those most likely to tolerate treatment and derive DFS benefit.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1078-0432
• Sprache: Englisch