POSTOPERATIVE HIGH NEUTROPHIL-LYMPHOCYTE RATIO PREDICTS SURVIVAL IN RENAL CELL CARCINOMA

Öz

Objective: The neutrophil-lymhocyte ratio (NLR) has been used as a marker of systemic inflammatory response and various studies confirmed it affects overall survival in renal cell carcinom (RCC). Most studies used NLR as a poor prognostic factor when assesed preoperatively. The aim of our study is to demonstrate the postoperative NLR as a poor prognostic factor.

Material and Methods: We reviewed 135 patients with RCC who were treated and followed in Kocaeli Univercity Medical Oncology Department between 2003 and 2014. Overall survival and progression free survival were assesed by using Kaplan-Maier method and prognostic significance of NLR and other independent factors were assesed by using cox regression models.

Results: Univariate and multivariate analyses showed that T stage (HR:1.86; 95% Cl:1.2-2.5 p:0.003), hemoglobin count (HR:0.51; 95% Cl:0.34-0.76 p:0.001) and NLR (HR: 2.6; 95% Cl:1.1-5.5 p:0.017) as independent prognostic factors for overall survival.

Conclusion: An increased NLR even after partial or radical nephrectomy can be a prognostic marker for RCC. In addition to recent studies which found preoperative NLR is a poor prognostic factor in RCC, we found postoperative NLR has a significance in overall survival.

Anahtar Kelimeler

• Neutrophil lymphocyte ratio,renal cell carcinom,survival

Yüksek Nötrofil- Lenfosit Oranının Renal Hücreli Karsinomda Preoperatif ve Postoperatif Dönemde Sağkalıma Etkisi

Öz

Amaç: Nötrofil-lenfosit oranı (NLO) sistemik inflamatuar yanıtı gösteren belirteçlerden biridir ve birçok çalışma renal hücreli karsinomda (RHK) genel sağkalımı etkilediğini ispatlamıştır. Yapılmış çalışmalarda NLO genellikle nefrektomi öncesi bakılmış ve kötü prognostik faktör olarak değerlendirilmiştir. Bu çalışmada postoperatif NLO’nun prognostik önemini göstermeyi amaçladık.

Gereç ve Yöntemler: 2003 ile 2014 tarihleri arasında Kocaeli Üniversitesi Medikal Onkoloji kliniğinde takip ve tedavi olan 135 hasta geriye dönük olarak incelendi. Genel sağkalım ve progresyonsuz sağkalım Kaplan-Maier metoduyla NLO ve diğer bağımsız değişkenlerin prognostik önemi cox regresyon modeliyle hesaplandı.

Bulgular: Univariete ve multivariete analizlerde T evresi (HR:1.86; %95 Cl:1.2-2.5 p:0.003), hemoglobin seviyesi (HR:0.51; %95 Cl:0.34-0.76 p:0.001) ve preoperatif NLO (HR:2.6; %95 Cl:1.1-5.5 p:0.017) RHK hastalarında genel sağkalımı etkileyen bağımsız faktörler olarak görüldü.

Sonuç: Parsiyel ya da radikal nefrektomi yapılmış RHK hastalarında artmış NLO oranı prognostik belirteç olarak kullanılabilir. Geçmiş çalışmalarda preoperatif NLO yüksekliğinin öneminin vurgulanmasına ek olarak çalışmamızla postoperatif NLO seviyesinin önemi gösterilmiştir.

Anahtar Kelimeler

• Nötrofil lenfosit oranı,renal hücreli karsinom,sağkalım

Kaynakça

1. 1- Chow WH, Dong LM, Devesa SS Epidemiology and risk factors for kidney cancer. Nat Rev Urol. 2010 May;7(5):245-57
2. 2- Siegel R, Ward E, Brawley O, Jemal A Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011;61(4):212
3. 3- SEER Stat Fact Sheets: Kidney and Renal Pelvis http://seer.cancer.gov/statfacts/html/kidrp.html
4. 4- Zisman A, Pantuck AJ, Wieder J et al: Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma. J Clin Oncol 2002; 20: 4559
5. 5- Kattan MW, Reuter V, Motzer RJ, Katz J, Russo P (2001) :A postoperative prognostic nomogram for renal cell carcinoma. J Urol 166(1):63-67
6. 6- Aliustaoglu M, Bilici A, Seker M, et al (2010). The association of pre-treatment peripheral blood markers with survival in patients with pancreatic cancer. Hepatogastroenterology, 57, 640-5.
7. 7- Ozdemir Y, Akin ML, Sucullu I, et al (2014). Pretreatment neutrophil/lymphocyte ratio as a prognostic aid in colorectal cancer. Asian Pac J Cancer Prev, 15, 2647-0.
8. 8- Kaya V, Yildirim M, Demirpence O, et al (2013). Prognostic significance of basic laboratory methods in non- small-celllung cancer. Asian Pac J Cancer Prev, 14, 5473-6

9. 9- Gunduz S. Prognostic Value of Hematologic Parameters in Patients with Metastatic Renal Cell Carcinoma Using Tyrosine Kinase Inhibitors. Asian Pac J Cancer Prev, 15, 3801-4
10. 10- Roxburgh CS, McMillan DC (2010). Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol, 6, 149–3.
11. 11- Keizman D, Ish-Shalom M, Huang P, et al (2012). The association of pre-treatment neutrophil to lymphocyte ratio with response rate, progression free survival and overall survival of patients treated with sunitinib for metastatic renal cell carcinoma. Eur J Cancer, 48, 202-8
12. 12- Michela de Martino, Allan J. Pantuck, Sebastian Hofbauer, et al (2013). Prognostic Impact of Preoperative Neutrophil-to-Lymphocyte Ratio in Localized Nonclear Cell Renal Cell Carcinoma. J urol, 190, 1999-4
13. 13- Fox P, Hdson M, Brown C. et al (2013). Markers of systemic inflammation predict survival in patients with advanced renal cell cancer. Br J Cancer,109, 147-3
14. 14- Keskin S, Keskin Z, Taskapu HH, et al (2014). Prognostic value of preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios, and multiphasic renal tomography findings in histological subtypes of renal cell carcinom. BMC Urol, 26, 95
15. 15- Motzer RJ, Mazumdar M, Bacik J, et al (1999). Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol, 17, 2530-0
16. 16- Viers B, Houston T, Boorjian S, et al (2014) Preoperative neutrophil- lymphocyte ratio predicts death among patients with localized clear cell renal carcinoma undergoing nephrectomy. Urol Oncol, 32, 1277-4
17. 17- Heng DY, Xie W, Regan MM, et al (2009). 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, 27, 5794-9
18. 18- Suzuki K, Aiura K, Ueda M, et al (2004). The influence of platelets on the promotion of invasion by tumor cells and inhibition by antiplatelet agents. Pancreas, 29, 132-0
19. 19- Pichler M, Hutterer GC, Stoeckigt C, et al (2013). Validation of the pre-treatment neutrophil-lymphocyte ratio as a prognostic factor in a large European cohort of renal cell carcinoma patients. Br J Cancer, 108, 901-7