NEUTROPHIL- AND PLATELET-TO-LYMPHOCYTE RATIOS AS PROGNOSTIC FACTORS OF DISEASE-FREE SURVIVAL IN HIGH-RISK RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) II (MP25)1 Apr 2019MP25-17 NEUTROPHIL- AND PLATELET-TO-LYMPHOCYTE RATIOS AS PROGNOSTIC FACTORS OF DISEASE-FREE SURVIVAL IN HIGH-RISK RENAL CELL CARCINOMA Anup Patel*, Alain Ravaud, Robert Motzer, Allan Pantuck, Michael Staehler, Bernard Escudier, Jean-François Martini, Mariajose Lechuga, Xun Lin, and Daniel George Anup Patel*Anup Patel* More articles by this author , Alain RavaudAlain Ravaud More articles by this author , Robert MotzerRobert Motzer More articles by this author , Allan PantuckAllan Pantuck More articles by this author , Michael StaehlerMichael Staehler More articles by this author , Bernard EscudierBernard Escudier More articles by this author , Jean-François MartiniJean-François Martini More articles by this author , Mariajose LechugaMariajose Lechuga More articles by this author , Xun LinXun Lin More articles by this author , and Daniel GeorgeDaniel George More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555662.04204.2cAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are reported to predict clinical outcomes in patients with metastatic renal cell carcinoma (mRCC). Adjuvant sunitinib (SU) significantly improved disease-free survival (DFS) vs placebo (PBO) in patients with loco-regional RCC at high risk of recurrence post nephrectomy (S-TRAC trial). This study aimed to evaluate NLR and PLR as potential prognostic factors in high-risk loco-regional non-metastatic RCC. METHODS: Post-hoc exploratory analysis of the high-risk S-TRAC trial patients. Kaplan-Meier estimates and Cox proportional analyses were performed on baseline and change from baseline at Week 4 NLR and PLR to assess their association with DFS. P-values were two-sided and based on an unstratified log-rank test. RESULTS: 609/615 patients had NLR and PLR baseline values; 574 patients had paired values at both baseline and at Week 4. Cut-off values were defined as NLR <3 vs ≥3 and PLR <140 vs ≥140, based on ROC curves. The significantly shorter DFS of baseline NLR <3 vs NLR ≥3 in PBO patients (HR 0.63, P=0.04), was eliminated by SU treatment (HR 0.91, P=0.67). SU Patients with baseline NLR <3 had significantly longer DFS vs PBO (median DFS 7.1 vs 4.7 years; HR 0.71, P=0.02); however, DFS was similar regardless of treatment for baseline NLR ≥3 (HR 1.03, P=0.91). No statistically significant differences in DFS were observed for baseline PLR (<140 vs ≥140) in the overall (HR 0.91, P=0.45), SU (HR=0.83, P=0.33) or PBO (HR=0.97, P=0.87) population; however, there was a trend toward longer DFS in SU patients with baseline PLR <140. Overall, a ≥25% decrease in NLR or PLR at Week 4 was associated with longer DFS vs no change (NLR, HR 0.71 [P=0.01]; PLR, HR 0.76 [P=0.05]). A greater proportion of patients had a ≥25% decrease in NLR or PLR at Week 4 when treated with SU (NLR, n=200 [71.2%]; PLR, n=175 [62.3%]) vs PBO (NLR, n=51 [17.4%]; PLR, n=43 [14.7%]). Patients with ≥25% decrease in NLR or PLR at Week 4 continued on to receive a higher median cumulative dose of SU (NLR 10137.5 mg; PLR 9856.3 mg) vs those with no change (NLR 8168.8 mg; PLR 9418.8 mg) or ≥25% increase (NLR 6712.5 mg; PLR 6425.0 mg). CONCLUSIONS: Low baseline NLR, and a ≥25% decrease in NLR or PLR after 4 weeks, could both be early predictors of those high-risk patients most likely to benefit from adjuvant SU. NLR and PLR changes at Week 4 appeared to separate those most likely to tolerate and respond to adjuvant SU, eliminating potential toxicity risk in those least likely to benefit. Source of Funding: Pfizer Inc. London, United Kingdom; Bordeaux, France; New York, NY; Los Angeles, CA; Munich, Germany; Villejuif, France; La Jolla, CA; Milan, Italy; La Jolla, United Kingdom; Durham, NC© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e350-e350 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anup Patel* More articles by this author Alain Ravaud More articles by this author Robert Motzer More articles by this author Allan Pantuck More articles by this author Michael Staehler More articles by this author Bernard Escudier More articles by this author Jean-François Martini More articles by this author Mariajose Lechuga More articles by this author Xun Lin More articles by this author Daniel George More articles by this author Expand All Advertisement PDF downloadLoading ...