Predictive value of inflammation-based prognostic scores in patients with metastatic renal cell carcinoma treated with cytoreductive nephrectomy

// Hironori Fukuda 1 , Toshio Takagi 1 , Tsunenori Kondo 2 , Satoru Shimizu 3 and Kazunari Tanabe 1 1 Department of Urology, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo, Japan 2 Department of Urology, Tokyo Women’s Medical University Medical Center East, Arakawa-ku, Tokyo, Japan 3 Department of Medical Education, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo, Japan Correspondence to: Toshio Takagi, email: t.takagi1192@gmail.com Keywords: renal cell carcinoma; metastasis; cytoreductive nephrectomy; prognosis; inflammation-based prognostic score Received: July 26, 2017 Accepted: February 10, 2018 Epub: February 16, 2018 Published: March 06, 2018 ABSTRACT Inflammation-based prognostic scores are useful for predicting survival in various cancers. Here, we aimed to determine the most useful inflammation-based prognostic score for predicting survival in patients with metastatic renal cell carcinoma undergoing cytoreductive nephrectomy. We retrospectively analyzed the data of 152 patients who underwent cytoreductive nephrectomy for metastatic renal cell carcinoma between 1986 and 2015. In the multivariate stepwise analysis, the combination of age, Memorial Sloan-Kettering Cancer Center score, histology, sarcomatoid change, clinical nodal stage, brain metastasis, and liver metastasis was a significant predictor for survival (Harrell's concordance index [c-index]: 0.638). The c-index of the combination improved with the addition of an inflammation-based prognostic score: C-reactive protein (c-index: 0.672), Glasgow prognostic score (c-index: 0.674), neutrophil-to-lymphocyte ratio (c-index: 0.685), lymphocyte-to-monocyte ratio (c-index: 0.670), platelet-to-lymphocyte ratio (c-index: 0.666), systemic inflammation response index (c-index: 0.652), and systemic immune-inflammation index (c-index: 0.678). The neutrophil-to-lymphocyte ratio provided the greatest improvement in the c-index. Additional multivariate analysis showed that the neutrophil-to-lymphocyte ratio was an independent prognostic factor for survival ( P < 0.0001). The neutrophil-to-lymphocyte ratio was the most useful inflammation-based prognostic score for predicting survival in patients with metastatic renal cell carcinoma treated with cytoreductive nephrectomy.