Systemic immune-inflammation index predicts the clinical outcome in patients with metastatic renal cell cancer treated with sunitinib

// Cristian Lolli 1 , Umberto Basso 2 , Lisa Derosa 3 , Emanuela Scarpi 1 , Teodoro Sava 4 , Matteo Santoni 5 , Simon J. Crabb 6 , Francesco Massari 4, 8 , Michele Aieta 7 , Vincenza Conteduca 1 , Marco Maruzzo 2 , Francesca La Russa 4 , Matthew Wheater 6 , Rossana Berardi 5 , Luca Galli 3 , Ugo De Giorgi 1 1 Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy 2 Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy 3 Oncology Unit 2, University Hospital of Pisa, Pisa, Italy 4 Department of Medical Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy 5 Department of Medical Oncology, Polytechnic University of the Marche Region, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I-GM Lancisi and G Salesi, Ancona, Italy 6 Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK 7 Department of Medical Oncology, IRCCS CROB Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy 8 Present address: Division of Oncology, S.Orsola-Malpighi Hospital, Bologna, Italy Correspondence to: Ugo De Giorgi, email: ugo.degiorgi@irst.emr.it Keywords: systemic immune inflammation index, renal cell carcinoma, RCC, prognostic factor, sunitinib Received: April 20, 2016      Accepted: May 23, 2016      Published: July 09, 2016 ABSTRACT Background: In this retrospective analysis, we explored the prognostic and predictive value of the systemic immune-inflammation index (SII), based on lymphocyte, neutrophil, and platelet counts, at baseline and changes at week 6 during first-line sunitinib in patients with metastatic renal cell cancer (RCC). Results: Patients were stratified into high SII (≥ 730) and low SII (< 730) groups. SII was associated with objective response, p < 0.0001. The median PFS was 6.3 months (95% CI 5.5–8.9) in patients with SII ≥ 730 and 18.7 months (95% CI 14.7–22.8) in those with SII < 730, p < 0.0001. The median OS was 43.6 months (95% CI 35.3–52.1) in patients with SII < 730, and 13.5 months (95% CI 9.8–18.5) in those with SII ≥ 730, p < 0.0001. In multivariate analysis, performance status, IMDC score and SII were able to predict OS (HR = 3.29, HR = 1.71 and HR = 1.79, respectively). Materials and Methods: We included 335 consecutive RCC patients treated with first-line sunitinib. The X-tile 3.6.1 software (Yale University, New Haven, CT) was used for bioinformatic analysis of the data to determine the cutoff value of SII. Progression-free survival (PFS), overall survival (OS) and their 95% confidence interval (95% CI) were estimated by Kaplan-Meier method and compared with logrank test. The impact of SII conversion at week 6 of treatment on PFS and OS was evaluated by Cox regression analyses. Conclusions: The SII and its changes during treatment represent a powerful prognostic indicator of clinical outcome in patients with metastatic RCC.