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Sato MT, Ida A, Kanda Y, Takano K, Ohbayashi M, Kohyama N, Morita J, Fuji K, Sasaki H, Ogawa Y, Kogo M. Prognostic model for overall survival that includes the combination of platelet count and neutrophil-lymphocyte ratio within the first six weeks of sunitinib treatment for metastatic renal cell carcinoma. BMC Cancer 2022; 22:1214. [PMID: 36434552 PMCID: PMC9700994 DOI: 10.1186/s12885-022-10316-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 11/14/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The association between the combination of platelet count and neutrophil-lymphocyte ratio (COP-NLR) at the time of adverse events during sunitinib treatment and prognosis is unclear, and prognostic models combining the prognostic factors of sunitinib have not been well studied. Thus, we developed a prognostic model that includes the COP-NLR to predict the prognosis of patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib. METHODS We performed a retrospective cohort study of 102 patients treated with sunitinib for mRCC between 2008 and 2020 in three hospitals associated with Showa University, Japan. The primary outcome was overall survival (OS). The collected data included baseline patient characteristics, adverse events, laboratory values, and COP-NLR scores within the first 6 weeks of sunitinib treatment. Prognostic factors of OS were analyzed using the Cox proportional hazards model. The integer score was derived from the beta-coefficient (β) of these factors and was divided into three groups. The survival curves were visualized using the Kaplan-Meier method and estimated using a log-rank test. RESULTS The median OS was 32.3 months. Multivariable analysis showed that the number of metastatic sites, Memorial Sloan Kettering Cancer Center risk group, number of metastases, non-hypertension, modified Glasgow Prognostic Score, and 6-week COP-NLR were significantly associated with OS. A higher 6-week COP-NLR was significantly associated with a shorter OS (p < 0.001). The β values of the five factors for OS were scored (non-hypertension, mGPS, and 6-week COP-NLR = 1 point; number of metastatic sites = 2 points; MSKCC risk group = 3 points) and patients divided into three groups (≤ 1, 2-3, and ≥ 4). The low-risk (≤ 1) group had significantly longer OS than the high-risk (≥ 4) group (median OS: 99.0 vs. 6.2 months, p < 0.001). CONCLUSIONS This study showed that the COP-NLR within the first 6 weeks of sunitinib treatment had a greater impact on OS than the COP-NLR at the start of sunitinib treatment. The developed prognostic model for OS, including the 6-week COP-NLR, will be useful in decision-making to continue sunitinib in the early treatment stage of patients with mRCC.
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Affiliation(s)
- Miki Takenaka Sato
- grid.410714.70000 0000 8864 3422Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Ayuki Ida
- grid.410714.70000 0000 8864 3422Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Yuki Kanda
- grid.410714.70000 0000 8864 3422Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Kaori Takano
- grid.410714.70000 0000 8864 3422Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Masayuki Ohbayashi
- grid.410714.70000 0000 8864 3422Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Noriko Kohyama
- grid.410714.70000 0000 8864 3422Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Jun Morita
- grid.410714.70000 0000 8864 3422Department of Urology, Showa University School of Medicine, Tokyo, Japan
| | - Kohzo Fuji
- grid.482675.a0000 0004 1768 957XDepartment of Urology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Haruaki Sasaki
- grid.412808.70000 0004 1764 9041Department of Urology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yoshio Ogawa
- grid.410714.70000 0000 8864 3422Department of Urology, Showa University School of Medicine, Tokyo, Japan
| | - Mari Kogo
- grid.410714.70000 0000 8864 3422Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
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Abstract
In recent years, cancer care has been transformed by immune-based and targeted treatments. Although these treatments are effective against various solid organ malignancies, multiple adverse effects can occur, including thyroid dysfunction. In this review, the authors consider treatments for solid organ cancers that affect the thyroid, focusing on immune checkpoint inhibitors, kinase inhibitors, and radioactive iodine-conjugated treatments (I-131-metaiodobenzylguanidine). They discuss the mechanisms causing thyroid dysfunction, provide a framework for their diagnosis and management, and explore the association of thyroid dysfunction from these agents with patient survival.
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Affiliation(s)
- Anupam Kotwal
- Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE 68198, USA. https://twitter.com/DrAKotwal
| | - Donald S A McLeod
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia; Population Health Department, QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Queensland 4029, Australia.
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Bolzacchini E, Giordano M, Bertù L, Bregni M, Nigro O, Galli L, Antonuzzo A, Artale S, Barzaghi S, Danova M, Torchio M, Pinotti G, Dentali F. Prognostic role of hematologic parameters of metastatic renal cell carcinoma treated with sunitinib. TUMORI JOURNAL 2021; 108:502-509. [PMID: 34296630 DOI: 10.1177/03008916211033905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hemochrome parameters at the diagnosis of metastatic renal cell carcinoma (mRCC) and the development of macrocytosis during sunitinib therapy are considered prognostic. OBJECTIVE To evaluate the prognostic role of hematologic parameters and macrocytosis in mRCC treated with sunitinib. METHODS We analyzed clinical data of 100 patients with mRCC treated with sunitinib as first-line therapy in a retrospective multicenter study. We calculated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) at baseline and erythrocyte mean corpuscular volume (MCV) during therapy. We considered the following cutoffs: NLR >3, PLR >150, LMR <3, and MCV >100 fl. Clinical data histology, prior nephrectomy, Fuhrman grading, metastatic sites, Memorial Sloan-Kettering Cancer Center score, and Heng score were collected. Overall survival (OS) and progression-free survival (PFS) were calculated. Univariate and multivariate analysis using Cox regression model with time-dependent (macrocytosis) covariate were applied. RESULTS At the univariate analysis, low LMR was associated with shorter PFS and OS (p = 0.02 and p = 0.06, respectively). High PLR was associated with worse PFS (p = 0.005); median OS was 23 vs 28 months (p = 0.13). At the multivariate analysis, poor risk (Heng score), low LMR, and high PLR were associated with shorter PFS (hazard ratio 7.1, 1.5, and 2, respectively); poor PS and poor risk (Heng score) were related to worst OS. Macrocytosis was observed in 26 patients and was not prognostic of survival. CONCLUSIONS In our cohort of patients with mRCC treated with sunitinib, low LMR (>3) and high PLR (>150) were associated with shorter PFS. Macrocytosis was not prognostic.
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Affiliation(s)
- Elena Bolzacchini
- U.O. Oncologia, Ospedale Sant'Anna, ASST-Lariana, Como, Italy.,Dipartimento di Medicina e Chirurgia, Università degli Studi dell'Insubria di Varese, Varese, Italy
| | - Monica Giordano
- U.O. Oncologia, Ospedale Sant'Anna, ASST-Lariana, Como, Italy
| | - Lorenza Bertù
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell'Insubria di Varese, Varese, Italy
| | - Marco Bregni
- U.O. Oncologia,Ospedale di Circolo di Busto Arsizio, ASST della Valle Olona, Busto Arsizio, Italy
| | - Olga Nigro
- U.O. Oncologia,Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Luca Galli
- U.O. Oncologia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Andrea Antonuzzo
- U.O. Oncologia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Salvatore Artale
- U.O. Oncologia, Ospedale S.Antonio Abate, ASST della Valle Olona, Gallarate, Italy
| | - Sabrina Barzaghi
- U.O. Oncologia, Ospedale S.Antonio Abate, ASST della Valle Olona, Gallarate, Italy
| | - Marco Danova
- U.O. Medicina Interna od Indirizzo Oncologico, Ospedale Civile, ASST di Pavia, Vigevano, Italy
| | - Martina Torchio
- U.O. Medicina Interna od Indirizzo Oncologico, Ospedale Civile, ASST di Pavia, Vigevano, Italy
| | - Graziella Pinotti
- U.O. Oncologia,Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Francesco Dentali
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell'Insubria di Varese, Varese, Italy
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