Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma

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.