Immune marker prognostic after non-clear cell RCC surgery

Sep 24 2013

By Eleanor McDermid, Senior medwireNews Reporter

The preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with disease-free survival (DFS) in patients undergoing resection of localized non-clear cell renal cell carcinoma (RCC), research shows.

“Therefore, NLR may provide a meaningful adjunct for patient counseling and clinical trial entry,” say study author Tobias Klatte (Medical University of Vienna, Austria) and co-workers.

The researchers believe theirs is the first study to assess the NLR in patients with non-clear cell RCC. Previous studies have focused on patients with clear cell RCC and have produced conflicting results, although the team observes that the statistical methods were often “suboptimal.”

The current study included 281 patients (79 women), of whom 55.5% underwent radical and 44.5% partial nephrectomy. Prior to surgery, an increasing NLR was associated with a higher likelihood for lymph node metastasis (present in nine patients), as was the absolute neutrophil count but not the absolute lymphocyte count. These markers were not associated with any other clinical or pathologic variable, however.

Nonetheless, all three markers were significantly associated with DFS, rates of which were 95.1%, 93.5%, and 88.1% at 1, 2, and 5 years, respectively. On multivariate analysis, only the NLR remained associated with DFS, with each 1.0 increase conferring a 17% rise in the risk for recurrence.

Higher TNM group and Fuhrman grade and the presence of microvascular invasion were also independently associated with increased recurrence risk. These three variables together predicted recurrence with an accuracy of 78.8%; adding NLR to the model significantly increased its accuracy to 80.8%.

Klatte et al note that, because there are relatively few patients with non-clear cell RCC, they are rarely included in trials of adjunct treatments.

“In this regard NLR may represent a widely available, inexpensive biomarker for nonclear cell RCC,” they write in the Journal of Urology. “Its use as a meaningful adjunct to standard prognostic factors may help guide the surveillance and identification of patients at high risk who should be included in adjuvant clinical trials.”

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