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Title: Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma
Austin Authors: Day, Daphne;Kanjanapan, Yada;Kwan, Edmond;Yip, Desmond;Lawrentschuk, Nathan;Davis, ID;Azad, Arun A;Wong, Shirley;Rosenthal, Mark A;Gibbs, Peter;Tran, Ben
Affiliation: Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia
Department of Urology, Austin Health, Heidelberg, Victoria, Australia
Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, Victoria, Australia
School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
Department of Medical Oncology, Western Health, Sunshine, Victoria, Australia
Biogrid Australia, The Royal Melbourne Hospital, Parkville, Victoria, Australia
Walter and Eliza Hall Institute, Parkville, Victoria, Australia
Issue Date: Nov-2016 2016-08-10
Publication information: Internal Medicine Journal 2016; 46(11): 1291-1297
Abstract: BACKGROUND: The role of cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) in the era of targeted therapies is currently undefined. In recent years, neutrophil-to-lymphocyte ratio (NLR) has emerged as a prognostic marker in several cancers including mRCC. In this multi-centre retrospective study, we aim to assess the impact of CN in mRCC and the value of NLR in risk stratification and patient selection. METHODS: Retrospective data from patients with de novo mRCC from 4 large Australian hospitals were collected. Survival analyses were performed using the Kaplan-Meier method and compared using the log-rank test. Multivariate analyses used the Cox proportional hazards method. RESULTS: Our study identified 91 de novo mRCC patients. Patients who underwent CN (n = 46, 51%) were more likely to be younger (59.0y vs. 64.6y, p = 0.019), and to have received systemic therapy (91% vs. 76%, p = 0.043). Median overall survival (mOS) was significantly improved in patients who underwent CN (23.0mo vs. 10.9mo, HR 0.33, 95% CI 0.20-0.55, p < 0.0001). Patients with NLR≥5 also had inferior mOS (6.2mo vs. 16.7mo, HR 1.94, 95% CI 1.14-3.29, p = 0.014). CN was associated with substantially improved survival in patients with both NLR<5 (mOS 31.1mo vs. 7.0mo; HR 0.41; 95% CI, 0.18-0.64; p = 0.0009) and NLR≥5 (mOS 10.9mo vs. 2.3mo; HR 0.33; 95% CI, 0.11-0.69; p = 0.009). Significant survival benefits associated with CN were maintained in multivariate analyses (HR 0.39; 95% CI, 0.22-0.70; p = 0.0014). CONCLUSIONS: CN is associated with significantly improved OS in de novo mRCC. The incremental survival benefit associated with CN was seen irrespective of NLR.
DOI: 10.1111/imj.13202
ORCID: 0000-0001-8553-5618
PubMed URL:
Type: Journal Article
Subjects: Cytoreductive nephrectomy
Neutrophil-to-lymphocyte ratio
Renal cell carcinoma
Appears in Collections:Journal articles

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