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.

摘要 目的：为阐明系统性炎症反应在接受舒尼替尼（sunitinib）治疗的转移性肾细胞癌（metastatic renal cell carcinoma, mRCC）患者中的预后价值，本研究评估了C反应蛋白（C-reactive protein, CRP）动力学的预后作用，并对比了包含CRP动力学与中性粒细胞-淋巴细胞比率（neutrophil-to-lymphocyte ratio, NLR）动力学的预后模型。材料与方法：本研究回顾性纳入复旦大学附属肿瘤医院连续收治的94例接受舒尼替尼治疗的mRCC患者。根据CRP与NLR的动态变化，将患者分为三组以分析二者的动力学特征；评估生存结局与潜在预后因素间的关联，并对预后预测的增量价值进行评价。结果：三组CRP动力学患者的总生存期（overall survival, OS）存在显著统计学差异（P<0.001）。非升高组的中位总生存期较正常化组延长近1.3倍（33.0 vs. 26.3个月），较未正常化组延长2倍（33.0 vs. 14.0个月）。多因素分析显示，CRP与NLR动力学均为独立预后指标。包含CRP动力学的模型预测准确性优于包含NLR动力学的模型，该结论得到了C指数（0.731 vs. 0.684）及似然比χ²检验（79.9% vs. 44.9%）的支持。结论：本研究表明，CRP的动态变化可更好地预测接受舒尼替尼治疗的mRCC患者的生存结局。在靶向治疗前后常规检测CRP水平，有助于识别预后不良的高危患者。