1
|
Saitta C, Afari JA, Patil D, Tanaka H, Yuen KL, Wang L, Cortes J, Liu F, Mahmood M, Matian J, Mansour M, Puri D, Cerrato C, Nguyen MV, Hakimi K, Kobayashi M, Fukuda S, Meagher MF, Fujii Y, Master V, Derweesh IH. Association of Elevated C-Reactive Protein with Worsened Outcomes in Different Histologies of Renal Cortical Tumors: Analysis of the INMARC Registry. Clin Genitourin Cancer 2024; 22:102098. [PMID: 38733897 DOI: 10.1016/j.clgc.2024.102098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 04/14/2024] [Accepted: 04/14/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND To evaluate relationship between histological subtypes of renal cell carcinoma (RCC) and preoperative c-reactive protein (CRP). PATIENTS AND METHODS We queried the International Marker Consortium for Renal Cancer database for patients affected by RCC. Patients were classified according to their histology: benign tumors, clear cell (cc) RCC, chromophobe (ch) RCC, papillary (p) RCC, and variant histology (vh) RCC; and according to CRP (mg/L): low CRP ≤5 and high CRP >5. Primary outcome was all-cause mortality (ACM). Secondary outcomes were cancer-specific mortality (CSM), recurrence and association between CRP and histology. Multivariable analysis (MVA) via Cox regression and multivariable logistic regression were fitted to elucidate predictors of outcomes. RESULTS Total 3902 patients (high CRP n = 1266) were analyzed; median follow up 51 (IQR 20-91) months. On MVA elevated CRP was an independent risk factor associated with increased risk of ACM in benign tumors (HR 5.98, P < .001), ccRCC (HR 2.69, P < .001), chRCC (HR 3.99, P < .001), pRCC (HR 1.76, P = .009) and vhRCC (HR 2.97, P =.007). MVA for CSM showed CRP as risk factor in ccRCC (HR 2.77, P < .001), chRCC (HR 6.16, P = .003) and pRCC (HR 2.29, P = .011), while in vhRCC was not (P = .27). MVA for recurrence reported CRP as risk factor for ccRCC (HR 1.30, P = .013), while in chRCC (P = .33), pRCC (P = .34) and vhRCC (P = .52) was not. On multivariable logistic regression CRP was a predictor of pRCC (OR 1.003, P = .002), while decreasing CRP was associated with benign tumors (OR 0.994, P = .048). CONCLUSION Elevated CRP was a robust predictor of worsened ACM in all renal cortical neoplasms. While most frequently observed in pRCC patients, elevated CRP was independently associated with worsened CSM in non-vhRCC. Conversely, elevated CRP was least likely to be noted in benign tumors, and elevation in this subgroup of patients should prompt further consideration for surveillance given increased risk of ACM. Further investigation is requisite.
Collapse
Affiliation(s)
- Cesare Saitta
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Jonathan A Afari
- Department of Urology, UC San Diego Health System, San Diego, CA
| | | | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kit L Yuen
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Luke Wang
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Julian Cortes
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Franklin Liu
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Mirha Mahmood
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Joshua Matian
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Mariam Mansour
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Dhruv Puri
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Clara Cerrato
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Mimi V Nguyen
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Kevin Hakimi
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Masaki Kobayashi
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Viraj Master
- Department of Urology, Emory Medical Center, Atlanta, GA
| | | |
Collapse
|
2
|
Kobayashi H, Kondo T, Iizuka J, Yoshida K, Takagi T. A retrospective cohort study of the impact of peripheral blood gamma- delta T cells to prognosis of nonmetastatic renal cell cancer after curative resection. Urol Oncol 2023; 41:488.e1-488.e9. [PMID: 37919100 DOI: 10.1016/j.urolonc.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023]
Abstract
AIM Gamma-delta-T cells (γδT) have potential antitumor roles and have recently been applied in adoptive immunotherapy. In the present study, we focused on the proportion of γδT cells in the peripheral blood just before surgery for renal cell cancer (RCC) and investigated whether their proportion affected recurrence-free survival (RFS) and overall survival (OS) retrospectively. PATIENTS AND METHODS A total of 137 patients with localized, non-metastatic RCC who received surgery at our institutes were analyzed retrospectively. The patients were divided into 2 groups: normal and low γδT cell groups based on the proportion of peripheral blood γδT cells. Kaplan-Meier curves were constructed to access the association of the proportion of peripheral blood γδT cells to RFS and OS. Cox regression were also constructed to access the risks to prognosis. Uni- and multivariate logistic regressions were performed to access associations between risk factors and, RFS and OS. RESULTS Among 137 patients, 40 had a proportion of γδT cells in peripheral blood of less than 1%, which was below the normal range. The remaining 97 patients had these cells in peripheral blood at 1% or higher. In the groups with low γδT cells, 13 patients had recurrences, and 9 patients dies during the observation period. In the groups with normal γδT cells, 16 patients had recurrences, and 8 patients died. The normal γδT cell group demonstrated significantly better prognosis in terms of RFS and OS. Multivariate analysis revealed that a low hemoglobin level, a low proportion of γδT cells, and a high pathological T stage (pT) were statistically independent risk factors for RFS. Age, albumin, C-reactive protein (CRP), % γδT cells, and pT were statistically significant factors affecting OS and only pT was an independent risk factor by multivariate analysis. CONCLUSION A low proportion of γδT cells was identified as one of the risk factors for RFS. Our findings will provide clues to develop strategies for early intervention in preventing recurrence even after complete resection of RCC and, such as adoptive immunotherapy using autologous γδT cells in patients with a low proportion of γδT cells.
Collapse
Affiliation(s)
- Hirohito Kobayashi
- Division of Transfusion and Cell-therapy, Tokyo Women's Medical University, Adachi Medical Center, Adachi-ku, Tokyo, Japan; Department of Urology, Tokyo Women's Medical University, Adachi Medical Center, Adachi-ku, Tokyo, Japan; Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University, Adachi Medical Center, Adachi-ku, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
3
|
Kobatake K, Ikeda K, Teishima J, Sekino Y, Babasaki T, Kohada Y, Tasaka R, Takemoto K, Fukushima T, Miyamoto S, Kitano H, Goto K, Hieda K, Hayashi T, Hinata N. Complexity in radiological morphology predicts worse prognosis and is associated with an increase in proteasome component levels in clear cell renal cell carcinoma. Front Oncol 2022; 12:1039383. [PMID: 36568232 PMCID: PMC9773190 DOI: 10.3389/fonc.2022.1039383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022] Open
Abstract
Background We previously reported preoperative radiological morphology (RM) as an independent predictor for pathological upstaging after partial nephrectomy in patients with T1 renal cell carcinoma (RCC). Purpose To investigate the prognostic importance of RM in all stages and the molecular characteristics underlying the differences between each type of RM in patients with clear cell RCC (ccRCC). Design setting and participants The Cancer Imaging Archive datasets (TCIA), comprising CT images and RNA-sequencing data, were used (n = 163). Specimens from 63 patients with ccRCC at our institution and their CT images were used. All images were divided into three types according to RM classification. Outcome measurements and statistical analysis Relationships with outcome were analyzed using Cox regression analysis and log-rank test. Results and limitations The irregular type was a significant independent predictor of worse disease-free survival (odds ratio: 2.22, p = 0.037) compared to round and lobular types in TCIA datasets. The irregular type showed a significant increase in both mRNA and protein expression of proteasome components, PSMB1 and PSMB3. Moreover, high expression of their coding genes shortened the progression-free survival of the patients with ccRCC who received sunitinib or avelumab plus axitinib therapy. The study limitations include the qualitative classification of RM and the need for novel radiomics and texture analysis techniques. Conclusions Investigating RM on pre-treatment CT scans can effectively predict worse prognosis. Increased RM complexity may indirectly predict drug sensitivity via increased expression of PSMB1 and PSMB3 in patients with ccRCC. Specific targeting of the ubiquitin-proteasome system might be a novel treatment strategy for ccRCC with increased RM complexity. Patient summary The clinical and morphological characteristics of patients with ccRCC vary greatly according to cancer staging. In this study, we built upon our prior findings of the prognostic importance of RM in T1 RCC and expanded it to encompass all stages of RCC, using a series of patients from a Japanese hospital.
Collapse
Affiliation(s)
- Kohei Kobatake
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenichiro Ikeda
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan,*Correspondence: Kenichiro Ikeda,
| | - Jun Teishima
- Department of Urology, Kobe City Hospital Organization Kobe City Medical Center West Hospital, Kobe, Japan
| | - Yohei Sekino
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takashi Babasaki
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuki Kohada
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryo Tasaka
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenshiro Takemoto
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takafumi Fukushima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shunsuke Miyamoto
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Kitano
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keisuke Goto
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keisuke Hieda
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuyuki Hinata
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
4
|
Ishiyama Y, Kondo T, Ishihara H, Yoshida K, Iizuka J, Tanabe K, Takagi T. C-reactive protein kinetics to predict recurrence of high-risk renal cell carcinoma after radical surgery. Int J Clin Oncol 2022; 27:969-976. [PMID: 35150349 DOI: 10.1007/s10147-022-02136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 01/31/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND With new options in adjuvant settings, clinical biomarkers to predict recurrence after radical surgery for high-risk renal cell carcinoma (hrRCC) are in need but are scarcely investigated. We aimed to verify the predictive value of perioperative C-reactive protein (CRP) kinetics on hrRCC recurrence. METHODS We retrospectively evaluated 154 patients who underwent radical surgery for hrRCC (≥ pT3 and/or N1-2 and M0) at two institutions. Patients were classified into Normal (< 0.5) and High (≥ 0.5) according to their preoperative serum CRP (mg/dL). The High group were further classified into Normalized (< 0.5 at post) or Non-normalized (≥ 0.5 at post), and recurrence-free survival (RFS) was compared between groups. Factors for RFS were further analysed, and Harrell's concordance index (C-index) for the accuracy of predicting RFS was compared with and without the addition of CRP-related variables to pre-existing models. RESULTS The RFS was significantly shorter in the High (n = 72, 46.8%) compared to the Normal (n = 82, 53.2%) group (9.7 vs. 66.7 months, p < 0.001). Within the High group, Non-normalized (n = 27, 17.5%) patients showed a significantly shorter RFS compared to the Normalized (n = 45, 29.2%) group (6.2 vs. 20.3, p = 0.009). In the multivariable stepwise analysis, CRP kinetics (hazard ratio 2.15, p = 0.029) effectively predicted RFS while baseline CRP fell short of significance. Higher C-index improvement was observed with CRP non-normalization than the baseline value when added to factors in the Karakiewicz and University of California Los Angeles Integrated Staging System models. CONCLUSIONS CRP kinetics effectively predicted RCC recurrence after surgery and may aid in decision-making for adjuvant systemic therapy.
Collapse
Affiliation(s)
- Yudai Ishiyama
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, 123-8558, Japan.,Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, 123-8558, Japan.
| | - Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, 123-8558, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| |
Collapse
|
5
|
Lee J, Suh J, Song C, You D, Jeong IG, Hong B, Hong JH, Kim CS, Ahn H. Association Between Sarcopenia and Survival of Patients with Organ-Confined Renal Cell Carcinoma after Radical Nephrectomy. Ann Surg Oncol 2021; 29:2473-2479. [PMID: 34625877 DOI: 10.1245/s10434-021-10881-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/13/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND We aimed to describe the effect of preoperative sarcopenia on oncologic outcomes of organ-confined renal cell carcinoma (RCC) after radical nephrectomy. PATIENTS AND METHODS A total of 632 patients with pT1-2 RCC who underwent radical nephrectomy between 2004 and 2014 were retrospectively analyzed. From preoperative computerized tomography (CT) scans, skeletal muscle index (SMI) was measured and gender-specific cutoff values at third lumbar vertebra of 52.4 cm2/m2 for men and 38.5 cm2/m2 for women were used to define sarcopenia. Survivals were compared and associations with sarcopenia were analyzed using Kaplan-Meier log rank tests and Cox proportional hazard regression models. Median follow-up was 83 months. RESULTS Of 632 patients, 268 (42.4%) were classified as sarcopenic. The sarcopenic group was more advanced in age (57 versus 53 years) and more predominantly male (71.3% versus 59.9%). Sarcopenic patients had lower body mass index (BMI, 23.0 versus 25.9 kg/m2), but there was no difference in tumor size, stage, or nuclear grade. Sarcopenia was associated with poorer overall survival (OS) and cancer-specific survival (CSS; OS 94.0% versus 82.1%; p < 0.001 and CSS 97.5% versus 91.8%; p < 0.001). On multivariate analysis, sarcopenia was an independent risk factor for all-cause mortality [hazard ratio (HR) 2.58; 95% CI 1.02-6.54] and cancer-specific mortality (HR 3.07; 95% CI 1.38-6.83). CONCLUSIONS Sarcopenia at diagnosis was an independent risk factor for all-cause and cancer-specific mortality after radical nephrectomy for pT1-2 RCC. These findings underscore the importance of assessing presence of sarcopenia for risk stratification even among surgical candidates.
Collapse
Affiliation(s)
- Jongpil Lee
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jungyo Suh
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Dalsan You
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - In Gab Jeong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Bumsik Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jun Hyuk Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Choung Soo Kim
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| |
Collapse
|
6
|
Chen L, Qi L, Zhang J, Ma Q, Chai X. Neutrophil-lymphocyte ratio as a prognostic factor for minute clear cell renal cell carcinoma diagnosed using multi-slice spiral CT. Medicine (Baltimore) 2021; 100:e26292. [PMID: 34115033 PMCID: PMC8202639 DOI: 10.1097/md.0000000000026292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/19/2021] [Indexed: 11/22/2022] Open
Abstract
Minute clear cell renal cell carcinoma (MccRCC) has a diameter of <1.5 cm and can be diagnosed using multi-slice spiral CT (MSCT). Recently, the role of the neutrophil-lymphocyte ratio (NLR) in the development of MccRCC has attracted attention. This study aimed to further explore the relationship between the NLR and MccRCC.This was a prospective study of 100 patients who were diagnosed with MccRCC using MSCT at Urumqi Friendship Hospital, China. The study investigated a series of pretreatment factors, including NLR and patients' general clinical data. Statistical methods employed included Pearson's chi-square test, Spearman-rho correlation test, Cox regression analysis, and receiver operator characteristic curve analysis.Based on Pearson's χ2, Spearman-rho test, and univariate/multivariate Cox regression analysis, the overall survival of patients with MccRCC was shown to be significantly related to NLR (P < .001). NLR (hazard ratio = 50.676, 95%CI, 17.543-146.390, P < .001) is a significant independent risk-factor for MccRCC. A receiver operator characteristic curve was plotted to examine specificity and sensitivity between NLR and MccRCC (area under curve = 0.958, P < .001).The level of the NLR plays a crucial role in the survival of patients with MccRCC, as diagnosed with MSCT. The higher the NLR, the worse the prognosis for patients with MccRCC.
Collapse
|
7
|
Wang H, Li X, Huang Q, Panic A, Shen D, Jia W, Zhang F, Fan Y, Gao Y, Gu L, Liu K, Peng C, Chen C, Duan J, Chen J, Wu S, Xuan Y, Wang C, Li H, Ma X, Zhang X, Wang B. Prognostic role of bland thrombus in patients treated with resection of renal cell carcinoma with inferior vena cava tumor thrombus. Urol Oncol 2021; 39:302.e1-302.e7. [PMID: 33678501 DOI: 10.1016/j.urolonc.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/19/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the impact of the presence of bland thrombus (BT) on prognosis of patients treated with resection of renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (IVCTT). MATERIALS AND METHODS The medical records of a total of 145 consecutive postsurgical RCC patients with level I-IV IVCTT were reviewed from January 2008 to August 2018. Associations of BT with clinicopathological variables were estimated by chi-square test or Student's t-test. Kaplan-Meier method and multivariate Cox proportional hazard model were used. The eighth TNM staging system, "Spiess PE" model, University of California at Los Angeles Integrated Staging System and Stage, Size, Grade, and Necrosis (SSIGN) score were selected to assess whether BT could improve their predictive abilities. RESULTS BT was observed in 34 (23.4%) patients and was significantly associated with increased levels of IVCTT (P = 0.004) and invasion of IVC wall (P = 0.030). Multivariable Cox analyses revealed that tumor grade, T stage, M stage, tumor thrombus consistency and BT were independent risk factors for both progression-free survival and overall survival. The concordance indexes ranged from a low of 0.652 in TNM to a high of 0.731 in SSIGN, and integrating BT into each base model led to an increased predictive accuracies of 6.2% for TNM (P = 0.025), 4.0% for "Spiess PE" model (P = 0.069), 2.1% for University of California at Los Angeles Integrated Staging System (P = 0.149) and 1.2% for SSIGN (P = 0.290), respectively. CONCLUSIONS Presence of BT was independently associated with survival in postsurgical patients with RCC-IVCTT. Routine consideration of BT as an adjunct to TNM staging system may be suggested.
Collapse
Affiliation(s)
- Hanfeng Wang
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Xintao Li
- Department of Urology, Air Force Medical Center, Beijing 100142, China
| | - Qingbo Huang
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Andrej Panic
- Department of Urology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Donglai Shen
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Wangping Jia
- Medical School of Chinese PLA, Beijing 100853, China.; Institute of geriatrics/National Clinical Research Center for Geriatrics Diseases, the Second Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Fan Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Yang Fan
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Yu Gao
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Kan Liu
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Cheng Peng
- Department of Urology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing 100007, China
| | - Changyu Chen
- Medical School of Chinese PLA, Beijing 100853, China.; School of Medicine, Nankai University, Tianjin 300071, China
| | - Junyao Duan
- Department of Urology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100007, China
| | - Jianwen Chen
- Medical School of Chinese PLA, Beijing 100853, China.; Dpartment of Nephrology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Shengpan Wu
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Yundong Xuan
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Chenfeng Wang
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Xin Ma
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853.
| | - Xu Zhang
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853.
| | - Baojun Wang
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853.
| |
Collapse
|
8
|
Li B, Huang D, Zheng H, Cai Q, Guo Z, Wang S. Preoperative serum total cholesterol is a predictor of prognosis in patients with renal cell carcinoma: a meta- analysis of observational studies. Int Braz J Urol 2020; 46:158-168. [PMID: 31961621 PMCID: PMC7025849 DOI: 10.1590/s1677-5538.ibju.2019.0560] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 10/03/2019] [Indexed: 09/04/2023] Open
Abstract
PURPOSE Several studies have demonstrated the strong correlation between the levels of preoperative serum total cholesterol (TC) and the survival of patients with surgically treated renal cell carcinoma (RCC). However, this association remains controversial. We performed a meta-analysis of published reports to evaluate the prognostic signifi cance of the preoperative serum TC levels for patients with surgically treated RCC. MATERIAL AND METHODS The databases from MEDLINE (via PubMed), Embase, Web of Science and Cochrane Library were systematically searched to identify the eligible studies published before August 2019. Multivariate adjusted hazard ratios (HRs) with 95% confi dence intervals (CIs) were calculated through inverse variance by using random effects models. RESULTS Nine cohort studies comprising 15.609 patients were identifi ed. Low preopera- tive serum TC levels were associated with poor cancer-specifi c survival (CSS; HR=0.98, 95% CI: 0.97-0.99; P=0.005; I2=74.2%) and progression-free survival (PFS; HR=0.69, 95% CI: 0.49-0.98; P=0.036; I2=80%) in patients with surgically treated RCC. However, no signifi cant association was observed between low preoperative serum TC levels and shorter overall survival (HR=0.93, 95% CI: 0.87-1.00; P=0.057; I2=86.2%). Sensitivity analyses validated the reliability and rationality of the results. CONCLUSIONS Preoperative serum TC level is an independent poor prognostic factor for patients with surgically treated RCC, with lower levels associated with worse CSS and PFS. Hence, this parameter may provide additional guidance in the selection of therapeutic strategies to improve prognosis, considering that cholesterol is a broadly applied routine marker in clinical practice.
Collapse
Affiliation(s)
- Bin Li
- Department of Urology, The Third Clinical Medical College of Yangtze University, Jingzhou Hospital of Traditional Chinese Medicine, Jingzhou, China
| | - Deliang Huang
- Department of Urology, The Third Clinical Medical College of Yangtze University, Jingzhou Hospital of Traditional Chinese Medicine, Jingzhou, China
| | - Huilan Zheng
- Department of Urology, The Third Clinical Medical College of Yangtze University, Jingzhou Hospital of Traditional Chinese Medicine, Jingzhou, China
| | - Qiang Cai
- Department of Urology, The Third Clinical Medical College of Yangtze University, Jingzhou Hospital of Traditional Chinese Medicine, Jingzhou, China
| | - Zhenlang Guo
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shusheng Wang
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
9
|
Uçar M, Soyupek S, Oksay T, Özorak A, Akkoç A, Topçuoğlu M, Demir M, Koşar A. Can we Predict Preoperative Tumor Aggressivity with Hemogram Parameters in Renal Cell Carcinoma? a Novel Calculation Method. J Med Syst 2019; 44:19. [PMID: 31823081 DOI: 10.1007/s10916-019-1491-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/17/2019] [Indexed: 12/01/2022]
Abstract
We aim to investigate the prognostic significance of the hemoglobin X lymphocyte / neutrophil ratio (HLNR) and hemoglobin x lymphocyte / platelet ratio (HLPR) with tumor aggressivity in patients with renal cell carcinoma. We retrospectively analyzed 127 patients' data who had diagnosed as renal cell carcinoma between 2008 and 2019 in Suleyman Demirel University Hospital. Tumor and patient characteristics, hemoglobin, neutrophil, lymphocyte, platelet values HLNR and HLPR were calculated in preoperative hemogram parameters. The relationship between tumor pathological stage, Fuhrman nuclear grade and tumor necrosis with HLPR and HLNR analyzed with statistically. There was a negative correlation between pathologic stage, Fuhrman nuclear grade and tumor necrosis with HLNR. P values are 0.003, 0.012 and 0.015 respectively. HLNR was lower in patients with high pathologic stage, high Fuhrman nuclear grade and accompanying tumor necrosis positiveness. There was a negative correlation between pathologic stage, Fuhrman nuclear grade and tumor necrosis with HLPR. P values are 0.001, 0.014 and 0.047 respectively. HLPR was lower in patients with high pathologic stage, high Fuhrman nuclear grade and accompanying tumor necrosis positiveness. High pathological stage, high Fuhrman nuclear grade and existence of tumor necrosis are associates with preoperative low HLNR and low HLPR in renal cell carcinoma patients. They can be used as prognostic markers in patients with renal mass preoperatively.
Collapse
Affiliation(s)
- Murat Uçar
- Alanya Alaaddin Keykubat University, School of Medicine, Antalya, Turkey.
| | - Sedat Soyupek
- Süleyman Demirel University, School of Medicine, Isparta, Turkey
| | - Taylan Oksay
- Süleyman Demirel University, School of Medicine, Isparta, Turkey
| | - Alper Özorak
- Süleyman Demirel University, School of Medicine, Isparta, Turkey
| | - Ali Akkoç
- Alanya Alaaddin Keykubat University, School of Medicine, Antalya, Turkey
| | - Murat Topçuoğlu
- Alanya Alaaddin Keykubat University, School of Medicine, Antalya, Turkey
| | - Murat Demir
- Süleyman Demirel University, School of Medicine, Isparta, Turkey
| | - Alim Koşar
- Süleyman Demirel University, School of Medicine, Isparta, Turkey
| |
Collapse
|
10
|
Brighi N, Farolfi A, Conteduca V, Gurioli G, Gargiulo S, Gallà V, Schepisi G, Lolli C, Casadei C, De Giorgi U. The Interplay between Inflammation, Anti-Angiogenic Agents, and Immune Checkpoint Inhibitors: Perspectives for Renal Cell Cancer Treatment. Cancers (Basel) 2019; 11:E1935. [PMID: 31817109 PMCID: PMC6966461 DOI: 10.3390/cancers11121935] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/30/2019] [Accepted: 12/01/2019] [Indexed: 12/12/2022] Open
Abstract
Treatment options for metastatic renal cell carcinoma (RCC) have been expanding in the last years, from the consolidation of several anti-angiogenic agents to the approval of immune checkpoint inhibitors (ICIs). The rationale for the use of immunomodulating agents derived from the observation that RCC usually shows a diffuse immune-cell infiltrate. ICIs target Cytotoxic T Lymphocytes Antigen 4 (CTLA-4), programmed death 1 (PD-1), or its ligand (PD-L1), showing promising therapeutic efficacy in RCC. PD-L1 expression is associated with poor prognosis; however, its predictive role remains debated. In fact, ICIs may be a valid option even for PD-L1 negative patients. The establishment of valid predictors of treatment response to available therapeutic options is advocated to identify those patients who could benefit from these agents. Both local and systemic inflammation contribute to tumorigenesis and development of cancer. The interplay of tumor-immune status and of cancer-related systemic inflammation is pivotal for ICI-treatment outcome, but there is an unmet need for a more precise characterization. To date, little is known on the role of inflammation markers on PD-1 blockade in RCC. In this paper, we review the current knowledge on the interplay between inflammation markers, PD-1 axis, and anti-angiogenic agents in RCC, focusing on biological rationale, implications for treatment, and possible future perspectives.
Collapse
Affiliation(s)
- Nicole Brighi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Alberto Farolfi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Vincenza Conteduca
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Giorgia Gurioli
- Bioscience Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (G.G.); (S.G.)
| | - Stefania Gargiulo
- Bioscience Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (G.G.); (S.G.)
| | - Valentina Gallà
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Giuseppe Schepisi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Cristian Lolli
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Chiara Casadei
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Ugo De Giorgi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| |
Collapse
|
11
|
Xie L, Wang Q, Dang Y, Ge L, Sun X, Li N, Han Y, Yan Z, Zhang L, Li Y, Zhang H, Guo X. OSkirc: a web tool for identifying prognostic biomarkers in kidney renal clear cell carcinoma. Future Oncol 2019; 15:3103-3110. [PMID: 31368353 DOI: 10.2217/fon-2019-0296] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: To develop a free and quick analysis online tool that allows users to easily investigate the prognostic potencies of interesting genes in kidney renal clear cell carcinoma (KIRC). Patients & methods: A total of 629 KIRC cases with gene expression profiling data and clinical follow-up information are collected from public Gene Expression Omnibus and The Cancer Genome Atlas databases. Results: One web application called Online consensus Survival analysis for KIRC (OSkirc) that can be used for exploring the prognostic implications of interesting genes in KIRC was constructed. By OSkirc, users could simply input the gene symbol to receive the Kaplan-Meier survival plot with hazard ratio and log-rank p-value. Conclusion: OSkirc is extremely valuable for basic and translational researchers to screen and validate the prognostic potencies of genes for KIRC, publicly accessible at http://bioinfo.henu.edu.cn/KIRC/KIRCList.jsp.
Collapse
Affiliation(s)
- Longxiang Xie
- Department of Preventive Medicine, Institute of Biomedical Informatics, Cell Signal Transduction Laboratory, Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Software, School of Basic Medical Sciences, Henan University, Kaifeng 475004, PR China
| | - Qiang Wang
- Department of Preventive Medicine, Institute of Biomedical Informatics, Cell Signal Transduction Laboratory, Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Software, School of Basic Medical Sciences, Henan University, Kaifeng 475004, PR China
| | - Yifang Dang
- Department of Preventive Medicine, Institute of Biomedical Informatics, Cell Signal Transduction Laboratory, Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Software, School of Basic Medical Sciences, Henan University, Kaifeng 475004, PR China
| | - Linna Ge
- Department of Preventive Medicine, Institute of Biomedical Informatics, Cell Signal Transduction Laboratory, Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Software, School of Basic Medical Sciences, Henan University, Kaifeng 475004, PR China
| | - Xiaoxiao Sun
- Department of Preventive Medicine, Institute of Biomedical Informatics, Cell Signal Transduction Laboratory, Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Software, School of Basic Medical Sciences, Henan University, Kaifeng 475004, PR China
| | - Ning Li
- Department of Preventive Medicine, Institute of Biomedical Informatics, Cell Signal Transduction Laboratory, Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Software, School of Basic Medical Sciences, Henan University, Kaifeng 475004, PR China
| | - Yali Han
- Department of Preventive Medicine, Institute of Biomedical Informatics, Cell Signal Transduction Laboratory, Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Software, School of Basic Medical Sciences, Henan University, Kaifeng 475004, PR China
| | - Zhongyi Yan
- Department of Preventive Medicine, Institute of Biomedical Informatics, Cell Signal Transduction Laboratory, Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Software, School of Basic Medical Sciences, Henan University, Kaifeng 475004, PR China
| | - Lu Zhang
- Department of Preventive Medicine, Institute of Biomedical Informatics, Cell Signal Transduction Laboratory, Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Software, School of Basic Medical Sciences, Henan University, Kaifeng 475004, PR China
| | - Yongqiang Li
- Department of Preventive Medicine, Institute of Biomedical Informatics, Cell Signal Transduction Laboratory, Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Software, School of Basic Medical Sciences, Henan University, Kaifeng 475004, PR China
| | - Haiyu Zhang
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Xiangqian Guo
- Department of Preventive Medicine, Institute of Biomedical Informatics, Cell Signal Transduction Laboratory, Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Software, School of Basic Medical Sciences, Henan University, Kaifeng 475004, PR China
| |
Collapse
|
12
|
Ohno Y. Role of systemic inflammatory response markers in urological malignancy. Int J Urol 2018; 26:31-47. [PMID: 30253448 DOI: 10.1111/iju.13801] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/20/2018] [Indexed: 12/14/2022]
Abstract
The systemic inflammatory response is associated with survival in patients with a variety of cancers. This inflammatory response is measured in the peripheral blood, and can be monitored using two categories of indices: concentration of specific serum proteins (albumin, C-reactive protein) and differential blood cell count (neutrophils, lymphocytes and platelets). Furthermore, combinations of these indices, such as the Glasgow Prognostic Score, which consists of the serum C-reactive protein and albumin level; the neutrophil-to-lymphocyte ratio; the platelet-to-lymphocyte ratio; and the prognostic nutritional index, which is based on peripheral blood lymphocyte count and serum albumin level, have also been evaluated and compared in cancer research. To date, there are hundreds of studies that have shown the prognostic value of systemic inflammatory response markers in patients with urological cancer. Most studies have evaluated the prognostic and predictive role of the pretreatment value of the markers, although some have focused on the role of the post-treatment value at specific points during the clinical course. The advantages of systemic inflammatory response markers are that they are easily measurable and inexpensive in the clinical setting. However, it is important to consider how clinicians use these markers in clinical practice. The present review provides a concise overview regarding systemic inflammatory markers in urological cancers, specifically C-reactive protein, Glasgow Prognostic Score/modified Glasgow Prognostic Score, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and prognostic nutritional index.
Collapse
Affiliation(s)
- Yoshio Ohno
- Department of Urology, Tokyo Medical University, Tokyo, Japan
| |
Collapse
|
13
|
Oh TK, Choi Y, Oh AY, Chung SH, Han S, Ryu JH. Abilities of Pre- and Postoperative High-Sensitivity C-Reactive Protein Levels to Predict 90-Day Mortality After Surgery for Abdominal and Thoracic Cancers. Ann Surg Oncol 2018; 25:3660-3666. [DOI: 10.1245/s10434-018-6734-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Indexed: 12/26/2022]
|
14
|
Sonuç Karaboğa MN, Sezgintürk MK. Determination of C-reactive protein by PAMAM decorated ITO based disposable biosensing system: A new immunosensor design from an old molecule. Talanta 2018; 186:162-168. [DOI: 10.1016/j.talanta.2018.04.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 12/18/2022]
|
15
|
Selby PJ, Banks RE, Gregory W, Hewison J, Rosenberg W, Altman DG, Deeks JJ, McCabe C, Parkes J, Sturgeon C, Thompson D, Twiddy M, Bestall J, Bedlington J, Hale T, Dinnes J, Jones M, Lewington A, Messenger MP, Napp V, Sitch A, Tanwar S, Vasudev NS, Baxter P, Bell S, Cairns DA, Calder N, Corrigan N, Del Galdo F, Heudtlass P, Hornigold N, Hulme C, Hutchinson M, Lippiatt C, Livingstone T, Longo R, Potton M, Roberts S, Sim S, Trainor S, Welberry Smith M, Neuberger J, Thorburn D, Richardson P, Christie J, Sheerin N, McKane W, Gibbs P, Edwards A, Soomro N, Adeyoju A, Stewart GD, Hrouda D. Methods for the evaluation of biomarkers in patients with kidney and liver diseases: multicentre research programme including ELUCIDATE RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BackgroundProtein biomarkers with associations with the activity and outcomes of diseases are being identified by modern proteomic technologies. They may be simple, accessible, cheap and safe tests that can inform diagnosis, prognosis, treatment selection, monitoring of disease activity and therapy and may substitute for complex, invasive and expensive tests. However, their potential is not yet being realised.Design and methodsThe study consisted of three workstreams to create a framework for research: workstream 1, methodology – to define current practice and explore methodology innovations for biomarkers for monitoring disease; workstream 2, clinical translation – to create a framework of research practice, high-quality samples and related clinical data to evaluate the validity and clinical utility of protein biomarkers; and workstream 3, the ELF to Uncover Cirrhosis as an Indication for Diagnosis and Action for Treatable Event (ELUCIDATE) randomised controlled trial (RCT) – an exemplar RCT of an established test, the ADVIA Centaur® Enhanced Liver Fibrosis (ELF) test (Siemens Healthcare Diagnostics Ltd, Camberley, UK) [consisting of a panel of three markers – (1) serum hyaluronic acid, (2) amino-terminal propeptide of type III procollagen and (3) tissue inhibitor of metalloproteinase 1], for liver cirrhosis to determine its impact on diagnostic timing and the management of cirrhosis and the process of care and improving outcomes.ResultsThe methodology workstream evaluated the quality of recommendations for using prostate-specific antigen to monitor patients, systematically reviewed RCTs of monitoring strategies and reviewed the monitoring biomarker literature and how monitoring can have an impact on outcomes. Simulation studies were conducted to evaluate monitoring and improve the merits of health care. The monitoring biomarker literature is modest and robust conclusions are infrequent. We recommend improvements in research practice. Patients strongly endorsed the need for robust and conclusive research in this area. The clinical translation workstream focused on analytical and clinical validity. Cohorts were established for renal cell carcinoma (RCC) and renal transplantation (RT), with samples and patient data from multiple centres, as a rapid-access resource to evaluate the validity of biomarkers. Candidate biomarkers for RCC and RT were identified from the literature and their quality was evaluated and selected biomarkers were prioritised. The duration of follow-up was a limitation but biomarkers were identified that may be taken forward for clinical utility. In the third workstream, the ELUCIDATE trial registered 1303 patients and randomised 878 patients out of a target of 1000. The trial started late and recruited slowly initially but ultimately recruited with good statistical power to answer the key questions. ELF monitoring altered the patient process of care and may show benefits from the early introduction of interventions with further follow-up. The ELUCIDATE trial was an ‘exemplar’ trial that has demonstrated the challenges of evaluating biomarker strategies in ‘end-to-end’ RCTs and will inform future study designs.ConclusionsThe limitations in the programme were principally that, during the collection and curation of the cohorts of patients with RCC and RT, the pace of discovery of new biomarkers in commercial and non-commercial research was slower than anticipated and so conclusive evaluations using the cohorts are few; however, access to the cohorts will be sustained for future new biomarkers. The ELUCIDATE trial was slow to start and recruit to, with a late surge of recruitment, and so final conclusions about the impact of the ELF test on long-term outcomes await further follow-up. The findings from the three workstreams were used to synthesise a strategy and framework for future biomarker evaluations incorporating innovations in study design, health economics and health informatics.Trial registrationCurrent Controlled Trials ISRCTN74815110, UKCRN ID 9954 and UKCRN ID 11930.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 3. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Peter J Selby
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rosamonde E Banks
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Walter Gregory
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christopher McCabe
- Department of Emergency Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Julie Parkes
- Primary Care and Population Sciences Academic Unit, University of Southampton, Southampton, UK
| | | | | | - Maureen Twiddy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Janine Bestall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Tilly Hale
- LIVErNORTH Liver Patient Support, Newcastle upon Tyne, UK
| | - Jacqueline Dinnes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Marc Jones
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | | | - Vicky Napp
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sudeep Tanwar
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK
| | - Naveen S Vasudev
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Baxter
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sue Bell
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - David A Cairns
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | - Neil Corrigan
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Peter Heudtlass
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Nick Hornigold
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michelle Hutchinson
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Carys Lippiatt
- Department of Specialist Laboratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew Potton
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Stephanie Roberts
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Sheryl Sim
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Sebastian Trainor
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Matthew Welberry Smith
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Neuberger
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Paul Richardson
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - John Christie
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Neil Sheerin
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - William McKane
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul Gibbs
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Naeem Soomro
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Grant D Stewart
- NHS Lothian, Edinburgh, UK
- Academic Urology Group, University of Cambridge, Cambridge, UK
| | - David Hrouda
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
16
|
Prognostic factors and prognostic models for renal cell carcinoma: a literature review. World J Urol 2018; 36:1943-1952. [PMID: 29713755 DOI: 10.1007/s00345-018-2309-4] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/24/2018] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Following curative treatment for localised renal cell carcinoma (RCC), up to 30% of patients develop tumour recurrence. Prognostic scores are essential to guide individualised surveillance protocols, patient counselling and potentially in the future to guide adjuvant therapy. In metastatic RCC, prognostic scores are routinely used for treatment selection in clinical practice as well as in all major trials. METHODS We performed a literature review on the current evidence based on prognostic factors and models for localised and metastatic RCC. RESULTS A number of prognostic factors have been identified, of which tumour node metastasis classification remains the most important. Multiple prognostic models and nomograms have been developed for localised disease, based on a combination of tumour stage, grade, subtype, clinical features, and performance status. However, there is poor level of evidence for their routine use. Prognostic scores for patients with metastatic RCC receiving targeted treatments are used routinely, but have limited accuracy. Molecular markers can improve the accuracy of established prognostic models, but frequently lack external, independent validation. CONCLUSION Several factors and models predict prognosis of localised and metastatic RCC. They represent valuable tools to provide estimates of clinically important endpoints, but their accuracy should be improved further. Validation of molecular markers is a future research priority.
Collapse
|
17
|
Murphy S, Zweyer M, Mundegar RR, Swandulla D, Ohlendieck K. Proteomic serum biomarkers for neuromuscular diseases. Expert Rev Proteomics 2018; 15:277-291. [DOI: 10.1080/14789450.2018.1429923] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sandra Murphy
- Department of Biology, Maynooth University, National University of Ireland, Maynooth, Ireland
| | - Margit Zweyer
- Department of Physiology II, University of Bonn, Bonn, Germany
| | | | | | - Kay Ohlendieck
- Department of Biology, Maynooth University, National University of Ireland, Maynooth, Ireland
| |
Collapse
|
18
|
Elevated preoperative neutrophil-lymphocyte ratio predicts upgrading at radical prostatectomy. Prostate Cancer Prostatic Dis 2017; 21:100-105. [PMID: 29230007 DOI: 10.1038/s41391-017-0015-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/15/2017] [Accepted: 09/06/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Neutrophil-lymphocyte ratio (NLR) is a widely used, representative marker of systemic inflammatory response within the body. NLR can be calculated from simple, inexpensive peripheral blood samples. High NLR is a negative prognostic factor in a variety of malignancies including urological tumors. In this study, we aim to assess the prognostic value of preoperative neutrophil- lymphocyte ratio (NLR) in patients treated with radical prostatectomy (RP) for localized prostate cancer (PCa). MATERIALS AND METHODS Records of 7426 patients were retrospectively analyzed from prospectively collected datasets. A cut-off point of 3 was taken for NLR based on ROC analyses and previous literature. RESULTS 23% (n = 1707) of patients had an NLR of ≥3. Patients with NLR ≥3 were more likely to harbor unfavorable pathological features such as higher biopsy Gleason score (GS), higher RP GS, higher rates of extra capsular extension, nodal involvement (all p < 0.001) and positive surgical margins (p = 0.002). On multivariable analyses, NLR ≥ 3 was associated with higher RP GS (OR 2.32; p < 0.001), seminal vesicle invasion (OR 1.60; p < 0.001) and nodal involvement (OR 1.43; p < 0.001). On multivariable analyses, NLR ≥ 3 was significantly associated with GS upgrading at RP (OR 1.39 p < 0.001). During a median follow up of 45 months, NLR ≥ 3 was associated with higher risk of BCR (p = 0.001). However, on multivariable Cox regression analysis such association was not shown (HR 0.86; p = 0.4). CONCLUSION Preoperative NLR ≥ 3 was associated with aggressive PCa, such as upgrading at RP. Even though its effect on clinical-decision making seems to be limited when all clinical and pathological confounders are taken into account, preoperative NLR may still be useful in selected patients to identify aggressive PCa helping patient selection for active surveillance protocols. Conversely, it does not predict BCR when adjusted for the effect of pathological features.
Collapse
|
19
|
Gorgel SN, Ozer K, Kose O, Dindar AS. Can preoperative neutrophil lymphocyte ratio predict malignancy in patients undergoing partial nephrectomy because of renal mass? Int Braz J Urol 2017; 44:461-466. [PMID: 29211406 PMCID: PMC5996777 DOI: 10.1590/s1677-5538.ibju.2017.0225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/30/2017] [Indexed: 12/21/2022] Open
Abstract
Purpose: To evaluate the importance of preoperative neutrophil lymphocyte ratio (NLR) predicting malignancy in patients who undergo partial nephrectomy due to renal mass. Materials and Methods: Seventy nine patients who underwent open partial nephrectomy for renal masses were included in this retrospective study. In preoperative routine blood tests, renal ultrasonography and contrast-enhanced computed tomography were performed for all patients. Preoperative neutrophil lymphocyte ratio were compared in patients with clear cell renal cell carcinoma (Group1, 65 patients) and benign lesions (Group 2, 14 patients). The predictive ability of NLR was analyzed by ROC curves and Youden Index method was used to identify the cut-off value for NLR. Results: The mean age of patients was 59.8±11.7 years in Group1 and 57.4±12.6 years in Group 2 (p=0.493). The mean tumor size was 3.8±1.2 cm in Group 1 and 3.3±1.0 cm in Group 2 (p=0.07). The median NLR was 2.48 (1.04) in Group 1 and 1.63 (0.96) in Group 2 (p<0.001). The area under a ROC curve was 0.799 (p<0.001). Conclusions: Preoperative neutrophil lymphocyte ratio may predict renal masses that can not be distinguished radiologically. Our results must be confirmed by large and properly designed prospective, randomized trials.
Collapse
Affiliation(s)
- Sacit Nuri Gorgel
- Department of Urology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir,Turkey
| | - Kutan Ozer
- Department of Urology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir,Turkey
| | - Osman Kose
- Department of Urology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir,Turkey
| | - Ahmet Selçuk Dindar
- Department of Urology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir,Turkey
| |
Collapse
|
20
|
Kinouchi T, Uemura M, Wang C, Ishizuya Y, Yamamoto Y, Hayashi T, Matsuzaki K, Nakata W, Yoshida T, Jingushi K, Kawashima A, Ujike T, Nagahara A, Fujita K, Imamura R, Ueda Y, Kitae K, Tsujikawa K, Nonomura N. Expression level of CXCL7 in peripheral blood cells is a potential biomarker for the diagnosis of renal cell carcinoma. Cancer Sci 2017; 108:2495-2502. [PMID: 28985012 PMCID: PMC5715254 DOI: 10.1111/cas.13414] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 12/25/2022] Open
Abstract
There are no blood biomarkers for the diagnosis of renal cell carcinoma (RCC) in routine clinical use. We focused on the gene expression profile of peripheral blood cells obtained from RCC patients to discover novel biomarkers for RCC diagnosis. Using microarray analysis and quantitative verification, CXCL7 was shown to be significantly upregulated in the peripheral blood cells of RCC patients. Importantly, aberrant CXCL7 expression was confirmed even in peripheral blood cells obtained from early stage (pT1a) RCC patients, and the expression level of CXCL7 in peripheral blood cells was a potential independent biomarker for the diagnosis of RCC by receiver operating characteristic curve analysis (sensitivity, 70.0%; specificity, 64.0%; area under the curve = 0.722; multiple logistic regression analysis: odds ratio, 1.07; 95% confidence interval, 1.03-1.11; P = 0.0004). Moreover, CXCL7 expression in peripheral blood cells significantly decreased after resection of the primary tumor. CXCL7 is more highly expressed in PBMCs than in neutrophils from both healthy controls and RCC patients. Interestingly, CXCL7 expression in PBMCs from healthy volunteers was significantly elevated following coculture with RCC cells compared to those cocultured with normal cells as a control. These results suggest that aberrant CXCL7 expression in peripheral blood cells is induced by RCC cells and may serve as a novel biomarker in the diagnosis of RCC.
Collapse
Affiliation(s)
- Toshiro Kinouchi
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Therapeutic Urologic Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Cong Wang
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yu Ishizuya
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiyuki Yamamoto
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takuji Hayashi
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kyosuke Matsuzaki
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Wataru Nakata
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takahiro Yoshida
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Jingushi
- Department of Therapeutic Urologic Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Atsunari Kawashima
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Ujike
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Nagahara
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryoichi Imamura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuko Ueda
- Laboratory of Molecular and Cellular Physiology, Osaka University Graduate School of Pharmaceutical Sciences, Suita, Japan
| | - Kaori Kitae
- Laboratory of Molecular and Cellular Physiology, Osaka University Graduate School of Pharmaceutical Sciences, Suita, Japan
| | - Kazutake Tsujikawa
- Laboratory of Molecular and Cellular Physiology, Osaka University Graduate School of Pharmaceutical Sciences, Suita, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| |
Collapse
|
21
|
Ishihara H, Kondo T, Yoshida K, Omae K, Takagi T, Iizuka J, Tanabe K. Evaluation of Preoperative Aspartate Transaminase/Alanine Transaminase Ratio as an Independent Predictive Biomarker in Patients With Metastatic Renal Cell Carcinoma Undergoing Cytoreductive Nephrectomy: A Propensity Score Matching Study. Clin Genitourin Cancer 2017; 15:598-604. [DOI: 10.1016/j.clgc.2017.04.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 04/04/2017] [Accepted: 04/09/2017] [Indexed: 12/22/2022]
|
22
|
Lunetta C, Lizio A, Maestri E, Sansone VA, Mora G, Miller RG, Appel SH, Chiò A. Serum C-Reactive Protein as a Prognostic Biomarker in Amyotrophic Lateral Sclerosis. JAMA Neurol 2017; 74:660-667. [PMID: 28384752 DOI: 10.1001/jamaneurol.2016.6179] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Importance Various factors have been proposed as possible candidates associated with the prognosis of amyotrophic lateral sclerosis (ALS); however, there is still no consensus on which biomarkers are reliable prognostic factors. C-reactive protein (CRP) is a biomarker of the inflammatory response that shows significant prognostic value for several diseases. Objective To examine the prognostic significance of CRP in ALS. Design, Setting, and Participants Patients' serum CRP levels were evaluated from January 1, 2009, to June 30, 2015, in a large cohort of patients with ALS observed by an Italian tertiary multidisciplinary center. Results were replicated in an independent cohort obtained from a population-based registry of patients with ALS. A post hoc analysis was performed of the phase 2 trial of NP001 to determine whether stratification by levels of CRP improves differentiation of responders and nonresponders to the drug. Main Outcomes and Measures Serum CRP levels from the first examination were recorded to assess their effect on disease progression and survival. Results A total of 394 patients with ALS (168 women and 226 men; mean [SD] age at diagnosis, 60.18 [13.60] years) were observed in a tertiary multidisciplinary center, and the analysis was replicated in an independent cohort of 116 patients with ALS (50 women and 66 men; mean [SD] age at diagnosis, 67.00 [10.74] years) identified through a regional population-based registry. Serum CRP levels in the 394 patients with ALS correlated with severity of functional impairment, as measured by total score on the ALS Functional Rating Scale-Revised, at first evaluation (r = -0.14818; P = .004), and with patient survival (hazard ratio, 1.129; 95% CI, 1.033-1.234; P = .007). Similar results were found in the independent cohort (hazard ratio, 1.044; 95% CI, 1.016-1.056; P ≤ .001). Moreover, a post hoc analysis of the phase 2 trial of NP001 using the same CRP threshold showed that patients with elevated baseline CRP levels receiving the higher dose of NP001 had significantly less functional impairment after the treatment period compared with patients with normal baseline CRP, regardless of whether patients with normal CRP levels received NP001 or placebo (3.00 [3.62] vs -7.31 [6.23]; P = .04). Conclusions and Relevance These findings suggest that patients with ALS and elevated serum CRP levels progress more rapidly than do those with lower CRP levels and that this elevation may reflect a neuroinflammatory state potentially responsive to the immune regulators such as NP001.
Collapse
Affiliation(s)
| | - Andrea Lizio
- NeuroMuscular Omnicentre, Fondazione Serena Onlus, Milano, Italy
| | - Eleonora Maestri
- NeuroMuscular Omnicentre, Fondazione Serena Onlus, Milano, Italy
| | - Valeria Ada Sansone
- NeuroMuscular Omnicentre, Fondazione Serena Onlus, Milano, Italy2Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Gabriele Mora
- Department of Neurological Rehabilitation, Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Scientifico di Milano, Milano, Italy
| | - Robert G Miller
- Forbes Norris MDA/ALS Research and Treatment Center, California Pacific Medical Center, San Francisco, California
| | - Stanley H Appel
- Peggy and Gary Edwards ALS Laboratory, Department of Neurology, Houston Methodist Neurological Institute, Houston, Texas6Houston Methodist Research Institute, Houston, Texas7Department of Neurology, Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas
| | - Adriano Chiò
- Amyotrophic Lateral Sclerosis Center, "Rita Levi Montalcini" Department of Neuroscience, Neurology II, University of Torino, Turin, Italy9Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| |
Collapse
|
23
|
Ishihara H, Kondo T, Yoshida K, Omae K, Takagi T, Iizuka J, Tanabe K. Effect of Systemic Inflammation on Survival in Patients With Metastatic Renal Cell Carcinoma Receiving Second-line Molecular-targeted Therapy. Clin Genitourin Cancer 2017; 15:495-501. [PMID: 28363437 DOI: 10.1016/j.clgc.2017.01.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/05/2017] [Accepted: 01/23/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The role of systemic inflammatory markers, including C-reactive protein (CRP), the neutrophil/lymphocyte ratio (NLR), and the platelet/lymphocyte ratio (PLR), in predicting survival for patients with metastatic renal cell carcinoma receiving second-line molecular-targeted therapy (mTT) after first-line tyrosine kinase inhibitor failure remains unclear. Thus, we investigated the relationship between systemic inflammation and survival in such patients. PATIENTS AND METHODS Sixty-three patients were evaluated. Progression-free survival (PFS) and overall survival (OS) after second-line mTT initiation were evaluated according to the inflammatory marker levels. In addition, the prognostic factors for survival were examined. RESULTS The receiver operating characteristic curves for CRP, NLR, and PLR had areas under the curve of 0.779, 0.619, and 0.655, respectively; no significant differences were noted. The corresponding cutoff values were 0.48, 2.53, and 183. Patients with higher CRP (n = 40), NLR (n = 32), and PLR (n = 22) levels had significantly lower PFS and OS than those with lower CRP, NLR, and PLR levels. Multivariate analyses showed that CRP was the sole independent predictor for PFS and OS. CONCLUSION Systemic inflammation is associated with survival after second-line mTT. In particular, CRP was a strong independent predictive biomarker of prognosis.
Collapse
Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
| | - Kazuhiko Yoshida
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Omae
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
24
|
Mbeutcha A, Shariat SF, Rieken M, Rink M, Xylinas E, Seitz C, Lucca I, Mathieu R, Rouprêt M, Briganti A, Karakiewicz PI, Klatte T. Prognostic significance of markers of systemic inflammatory response in patients with non–muscle-invasive bladder cancer. Urol Oncol 2016; 34:483.e17-483.e24. [DOI: 10.1016/j.urolonc.2016.05.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/23/2016] [Accepted: 05/12/2016] [Indexed: 12/14/2022]
|
25
|
Lucca I, Hofbauer SL, Leitner CV, de Martino M, Özsoy M, Susani M, Shariat SF, Klatte T. Development of a Preoperative Nomogram Incorporating Biomarkers of Systemic Inflammatory Response to Predict Nonorgan-confined Urothelial Carcinoma of the Bladder at Radical Cystectomy. Urology 2016; 95:132-8. [DOI: 10.1016/j.urology.2016.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/31/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
|
26
|
Li X, Ma X, Tang L, Wang B, Chen L, Zhang F, Zhang X. Prognostic value of neutrophil-to-lymphocyte ratio in urothelial carcinoma of the upper urinary tract and bladder: a systematic review and meta-analysis. Oncotarget 2016; 8:62681-62692. [PMID: 28977980 PMCID: PMC5617540 DOI: 10.18632/oncotarget.17467] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 02/20/2017] [Indexed: 12/11/2022] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) is an inflammation marker that has prognostic value for various tumors, but its prognostic value in urothelial carcinoma (UC) remains controversial. This meta-analysis investigated the prognostic value of NLR in UC. A systematic search was performed on PubMed, ISI Web of Science, and Embase for studies focusing on the association between NLR and clinical features or prognosis of UC and published until November 2016. Prognostic outcomes and clinical features were collected and analyzed. A total of 11,538 patients from 32 studies were included in the meta-analysis. Increased pretreatment NLR predicted poor overall survival (hazard ratio [HR] = 1.72, 95% confidence interval [CI] = 1.45–2.05), progression free survival (HR = 1.68, 95% CI = 1.44–1.96), and cancer specific survival (HR = 1.64, 95% CI = 1.39–1.93) in all the patients. The increased pretreatment NLR was correlated with increased lymphovascular invasion (HR = 1.29, 95% CI = 1.17–1.43), high tumor T stage (HR = 1.25, 95% CI = 1.12–1.39), and tumor grade (HR = 1.07, 95% CI = 1.01–1.14) but not with lymph node involvement, carcinoma in situ, multifocality, or positive margin. Our meta-analysis indicated that NLR could predict the prognosis for UC and was associated with UC progression in terms of lymphovascular invasion, tumor T stage, and tumor grade.
Collapse
Affiliation(s)
- Xintao Li
- Department of Urology, State Key Laboratory of Kidney Disease, Chinese PLA Medical Academy, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xin Ma
- Department of Urology, State Key Laboratory of Kidney Disease, Chinese PLA Medical Academy, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lu Tang
- Department of Urology, State Key Laboratory of Kidney Disease, Chinese PLA Medical Academy, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Baojun Wang
- Department of Urology, State Key Laboratory of Kidney Disease, Chinese PLA Medical Academy, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Luyao Chen
- Department of Urology, State Key Laboratory of Kidney Disease, Chinese PLA Medical Academy, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Fan Zhang
- Department of Urology, State Key Laboratory of Kidney Disease, Chinese PLA Medical Academy, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xu Zhang
- Department of Urology, State Key Laboratory of Kidney Disease, Chinese PLA Medical Academy, Chinese People's Liberation Army General Hospital, Beijing, China
| |
Collapse
|
27
|
Tang L, Li X, Wang B, Luo G, Gu L, Chen L, Liu K, Gao Y, Zhang X. Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Localized and Advanced Prostate Cancer: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0153981. [PMID: 27096158 PMCID: PMC4838250 DOI: 10.1371/journal.pone.0153981] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/06/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE AND BACKGROUND Increasing evidence suggests that inflammation plays an essential role in cancer development and progression. The inflammation marker neutrophil-lymphocyte ratio (NLR) is correlated with prognosis across a wide variety of tumor types, but its prognostic value in prostate cancer (PCa) remains controversial. In the present meta-analysis, the prognostic value of NLR in PCa patients is investigated. METHODS We performed a meta-analysis to determine the predictive value of NLR for overall survival (OS), recurrence-free survival (RFS), and clinical features in patients with PCa. We systematically searched PubMed, ISI Web of Science, and Embase for relevant studies published up to October 2015. RESULTS A total of 9418 patients from 18 studies were included in the meta-analysis. Elevated pretreatment NLR predicted poor OS (HR 1.628, 95% CI 1.410-1.879) and RFS (HR 1.357, 95% CI 1.126-1.636) in all patients with PCa. However, NLR was insignificantly associated with OS in the subgroup of patients with localized PCa (HR 1.439, 95% CI 0.753-2.75). Increased NLR was also significantly correlated with lymph node involvement (OR 1.616, 95% CI 1.167-2.239) but not with pathological stage (OR 0.827, 95% CI 0.637-1.074) or Gleason score (OR 0.761, 95% CI 0.555-1.044). CONCLUSIONS The present meta-analysis indicated that NLR could predict the prognosis for patients with locally advanced or castration-resistant PCa. Patients with higher NLR are more likely to have poorer prognosis than those with lower NLR.
Collapse
Affiliation(s)
- Lu Tang
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Xintao Li
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Baojun Wang
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Guoxiong Luo
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Liangyou Gu
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Luyao Chen
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Kan Liu
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Yu Gao
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Xu Zhang
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
- * E-mail:
| |
Collapse
|
28
|
Obata J, Tanaka N, Mizuno R, Kanao K, Mikami S, Matsumoto K, Kosaka T, Kikuchi E, Jinzaki M, Oya M. Plasma fibrinogen level: an independent prognostic factor for disease-free survival and cancer-specific survival in patients with localised renal cell carcinoma. BJU Int 2016; 118:598-603. [PMID: 26780664 DOI: 10.1111/bju.13414] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate the impact of perioperative plasma fibrinogen level as a biomarker of oncological outcome in localised renal cell carcinoma (RCC). PATIENTS AND METHODS We consecutively identified 601 patients with localised RCC who underwent curative surgery at a single institution. Subsequent disease recurrence and cancer-specific survival (CSS) were assessed using the Kaplan-Meier method. To evaluate the independent prognostic impact of plasma fibrinogen level, multivariate analysis was performed for these outcomes. RESULTS Using the defined threshold level of preoperative plasma fibrinogen of ≥420 mg/dL as elevated, we found 56 patients (9.3%) with an elevated plasma fibrinogen level preoperatively. In Kaplan-Meier analysis, there was a significant difference in disease-free survival and CSS rates between patients with and without preoperative plasma fibrinogen levels of ≥420 mg/dL. Multivariate analysis showed that elevated preoperative plasma fibrinogen level was an independent predictor of subsequent disease recurrence and cancer-specific mortality. In a subgroup analysis of the elevated preoperative plasma fibrinogen level group, postoperative normalisation of plasma fibrinogen level was significantly associated with CSS, showing that patients with non-normalised plasma fibrinogen levels tended to have a higher incidence of cancer-specific mortality after surgery. CONCLUSION Patients with elevated preoperative plasma fibrinogen levels could be significantly predicted to have subsequent tumour metastasis and cancer-specific mortality, while there was a significant difference in CSS between patients in the normalised and non-normalised postoperative plasma fibrinogen groups. While these are hypothesis generating results, plasma fibrinogen levels may be a useful biomarker due to its low cost and ease of assessment.
Collapse
Affiliation(s)
- Jun Obata
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - Kent Kanao
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Shuji Mikami
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | | | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
29
|
Sevcenco S, Mathieu R, Baltzer P, Klatte T, Fajkovic H, Seitz C, Karakiewicz PI, Rouprêt M, Rink M, Kluth L, Trinh QD, Loidl W, Briganti A, Scherr DS, Shariat SF. The prognostic role of preoperative serum C-reactive protein in predicting the biochemical recurrence in patients treated with radical prostatectomy. Prostate Cancer Prostatic Dis 2016; 19:163-7. [PMID: 26810014 DOI: 10.1038/pcan.2015.60] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/11/2015] [Accepted: 10/07/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND To assess the prognostic value of preoperative C-reactive protein (CRP) serum levels for prognostication of biochemical recurrence (BCR) after radical prostatectomy (RP) in a large multi-institutional cohort. METHODS Data from 7205 patients treated with RP at five institutions for clinically localized prostate cancer (PCa) were retrospectively analyzed. Preoperative serum levels of CRP within 24 h before surgery were evaluated. A CRP level ⩾0.5 mg dl(-1) was considered elevated. Associations of elevated CRP with BCR were evaluated using univariable and multivariable Cox proportional hazards regression models. Harrel's C-index was used to assess prognostic accuracy (PA). RESULTS Patients with higher Gleason score on biopsy and RP, extracapsular extension, seminal vesicle invasion, lymph node metastasis, and positive surgical margins status had a significantly elevated preoperative CRP compared to those without these features. Patients with elevated CRP had a lower 5-year BCR survival proportion as compared to those with normal CRP (55% vs 76%, respectively, P<0.0001). In pre- and postoperative multivariable models that adjusted for standard clinical and pathologic features, elevated CRP was independently associated with BCR (P<0.001). However, the addition of preoperative CRP did not improve the accuracy of the standard pre- and postoperative models for prediction of BCR (70.9% vs 71% and 78.9% vs 78.7%, respectively). CONCLUSIONS Preoperative CRP is elevated in patients with pathological features of aggressive PCa and BCR after RP. While CRP has independent prognostic value, it does not add prognostically or clinically significant information to standard predictors of outcomes.
Collapse
Affiliation(s)
- S Sevcenco
- Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria
| | - R Mathieu
- Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria.,Department of Urology, Rennes University Hospital, Rennes, France
| | - P Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - T Klatte
- Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria
| | - H Fajkovic
- Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria
| | - C Seitz
- Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria
| | - P I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
| | - M Rouprêt
- Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Kluth
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Q-D Trinh
- School of Medicine, Sacramento, CA, USA.,Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - W Loidl
- Department of Urology, Krankenhaus der Barmherzigen Schwestern, Linz, Austria
| | - A Briganti
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - D S Scherr
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - S F Shariat
- Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| |
Collapse
|
30
|
Preoperative Neutrophil-to-Lymphocyte Ratio and Neutrophilia Are Independent Predictors of Recurrence in Patients with Localized Papillary Renal Cell Carcinoma. BIOMED RESEARCH INTERNATIONAL 2015; 2015:891045. [PMID: 26448948 PMCID: PMC4573887 DOI: 10.1155/2015/891045] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/19/2015] [Indexed: 01/12/2023]
Abstract
Objective. To evaluate the role of preoperative neutrophil-to-lymphocyte ratio (NLR) and absolute neutrophil count (ANC) in patients' prognosis with localized papillary renal cell carcinoma (pRCC). Methods. Data from 218 localized pRCC patients (T1-3 N0/+ M0), operated between 1991 and 2011 at two centers, were evaluated retrospectively. Univariable and multivariable analyses using the Cox regression model were performed to determine the associations of NLR and ANC with recurrence-free survival (RFS). Prognostic accuracy was evaluated with the Harrell concordance index. Results. The 5-year RFS rate was 87.0%. Multivariable analysis identified increased NLR (≥3.6) and ANC (≥5300/μL) as independent prognostic factors for RFS (hazard ratio (HR) = 4.01, P = 0.018) and (HR = 4.71, P = 0.045). The final model built by the addition of NLR or ANC improved predictive accuracy (c-index: 0.824, 0.842) compared with the clinicopathological base model (c-index: 0.800), which included TNM stage and tumor necrosis. Conclusions. The NLR and ANC appear to be independent prognostic factors for RFS after surgery for localized pRCC. They significantly increase the accuracy of established prognostic factors. Therefore, we recommend adding NLR and ANC to traditional prognostic model, which may improve its predictive accuracy.
Collapse
|
31
|
de Martino M, Leitner CV, Hofbauer SL, Lucca I, Haitel A, Shariat SF, Klatte T. Serum Adiponectin Predicts Cancer-specific Survival of Patients with Renal Cell Carcinoma. Eur Urol Focus 2015; 2:197-203. [PMID: 28723535 DOI: 10.1016/j.euf.2015.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 05/24/2015] [Accepted: 06/30/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Prediction of outcomes in patients with renal cell carcinoma (RCC) is crucial for clinical decision-making. The limited accuracy of conventional prognostic factors such as stage and grade may be increased by the use of biomarkers. OBJECTIVE To evaluate the association of serum adiponectin and leptin and polymorphisms in the leptin and leptin receptor genes with RCC histopathology and prognosis. DESIGN, SETTING, AND PARTICIPANTS Adiponectin and leptin levels were measured in preoperative serum samples from 131 consecutive patients with sporadic unilateral RCC. The polymorphisms G-2548A (rs7799039) in the leptin gene (LEP) and Gln223Arg (Q223R, A668G, rs1137101) in the leptin receptor gene (LEPR) were genotyped in 233 patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable associations with RCC-specific survival were analyzed using Cox models. RESULTS AND LIMITATIONS Median preoperative serum adiponectin was 15.8μg/ml (interquartile range 10.0-23.1). Adiponectin was lower in patients with distant metastases (p=0.017) or histologic tumor necrosis (p=0.015). On multivariable analysis adjusted for the effects of variables in the Karakiewicz nomogram, each 1-μg/ml increase in adiponectin was associated with a 8% decrease in the hazard of death from RCC (hazard ratio 0.92, 95% confidence interval 0.86-0.98; p=0.007). The discrimination of the Karakiewicz nomogram increased by 0.6% on inclusion of adiponectin. Leptin levels, LEP G-2548A and LEPR Q223R were not associated with either RCC pathology or outcomes. Limitations include the retrospective study design, the low numbers of patients, and a lack of standardized follow-up. CONCLUSIONS This study suggests that lower preoperative serum adiponectin is associated with features of biologically aggressive RCC, metastasis, and survival. PATIENT SUMMARY We assessed the relationship between outcomes and blood levels of adiponectin and leptin and genetic changes in leptin and leptin receptor genes. We found that patients with lower adiponectin levels have more aggressive tumors and poorer survival.
Collapse
Affiliation(s)
- Michela de Martino
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Carmen V Leitner
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Sebastian L Hofbauer
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Ilaria Lucca
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Andrea Haitel
- Clinical Institute of Pathology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Tobias Klatte
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
| |
Collapse
|
32
|
Lucca I, Jichlinski P, Shariat SF, Rouprêt M, Rieken M, Kluth LA, Rink M, Mathieu R, Mbeutcha A, Maj-Hes A, Fajkovic H, Briganti A, Seitz C, Karakiewicz PI, de Martino M, Lotan Y, Babjuk M, Klatte T. The Neutrophil-to-lymphocyte Ratio as a Prognostic Factor for Patients with Urothelial Carcinoma of the Bladder Following Radical Cystectomy: Validation and Meta-analysis. Eur Urol Focus 2015; 2:79-85. [PMID: 28723455 DOI: 10.1016/j.euf.2015.03.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/16/2015] [Accepted: 03/12/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic inflammatory response has been proposed as a prognostic factor for patients with urothelial carcinoma of the bladder (UCB) following radical cystectomy (RC). OBJECTIVE To validate NLR as a prognostic biomarker and to perform a pooled meta-analysis. DESIGN, SETTING, AND PARTICIPANTS The NLR was assessed in 4061 patients within 30 days before RC. A systematic review of the literature was undertaken using electronic databases. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Associations with overall survival (OS) and cancer-specific survival (CSS) were evaluated using Cox models. Hazard ratios (HRs) were pooled in a meta-analysis using random-effects modeling. RESULTS AND LIMITATIONS A high NLR (≥2.7) was associated with advanced pathological tumor stages (p<0.001), lymph node involvement (p<0.001), lymphovascular invasion (p=0.008), and positive soft0tissue surgical margins (p=0.001). In multivariate analyses, a high NLR was independently associated with both OS (HR 1.11, 95% confidence interval [CI] 1.01-1.22; p=0.029) and cancer-specific survival (CSS) (HR 1.21, 95% CI 1.07-1.37, p=0.003). The discrimination of the multivariate models increased by 0.2% on inclusion of NLR. Five studies were included in the meta-analysis. The HR for NLR greater than the cutoff was 1.46 (95% CI 1.01-1.92) for OS and 1.51 (95% CI 1.17-1.85) for CSS. Limitations include the retrospective study design and the lack of standardized follow-up. CONCLUSION In patients with UCB treated with RC, a high preoperative NLR is associated with more advanced tumor stage, lymph node metastasis, and worse prognosis. The NLR may be a readily available and useful biomarker for preoperative prognostic stratification. PATIENT SUMMARY We investigated the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in patients with bladder cancer treated with radical cystectomy. We found that a high NLR is associated with worse oncologic outcomes, suggesting it could play a role in risk stratification.
Collapse
Affiliation(s)
- Ilaria Lucca
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Patrice Jichlinski
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
| | - Morgan Rouprêt
- Department of Urology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Faculty of Medicine Pierre et Marie Curie, University Paris 6, Paris, France
| | - Malte Rieken
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Luis A Kluth
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Romain Mathieu
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Rennes University Hospital, Rennes, France
| | - Aurelie Mbeutcha
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Agnes Maj-Hes
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Harun Fajkovic
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alberto Briganti
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QB, Canada
| | - Michela de Martino
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marko Babjuk
- Department of Urology, Hospital Motol, Second Faculty of Medicine, Prague, Czech Republic
| | - Tobias Klatte
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
33
|
Lucca I, de Martino M, Hofbauer SL, Zamani N, Shariat SF, Klatte T. Comparison of the prognostic value of pretreatment measurements of systemic inflammatory response in patients undergoing curative resection of clear cell renal cell carcinoma. World J Urol 2015; 33:2045-52. [PMID: 25894368 DOI: 10.1007/s00345-015-1559-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/08/2015] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Pretreatment measurements of systemic inflammatory response, including the Glasgow prognostic score (GPS), the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), the platelet-to-lymphocyte ratio (PLR) and the prognostic nutritional index (PNI) have been recognized as prognostic factors in clear cell renal cell carcinoma (CCRCC), but there is at present no study that compared these markers. METHODS We evaluated the pretreatment GPS, NLR, MLR, PLR and PNI in 430 patients, who underwent surgery for clinically localized CCRCC (pT1-3N0M0). Associations with disease-free survival were assessed with Cox models. Discrimination was measured with the C-index, and a decision curve analysis was used to evaluate the clinical net benefit. RESULTS On multivariable analyses, all measures of systemic inflammatory response were significant prognostic factors. The increase in discrimination compared with the stage, size, grade and necrosis (SSIGN) score alone was 5.8 % for the GPS, 1.1-1.4 % for the NLR, 2.9-3.4 % for the MLR, 2.0-3.3 % for the PLR and 1.4-3.0 % for the PNI. On the simultaneous multivariable analysis of all candidate measures, the final multivariable model contained the SSIGN score (HR 1.40, P < 0.001), the GPS (HR 2.32, P < 0.001) and the MLR (HR 5.78, P = 0.003) as significant variables. Adding both the GPS and the MLR increased the discrimination of the SSIGN score by 6.2 % and improved the clinical net benefit. CONCLUSIONS In patients with clinically localized CCRCC, the GPS and the MLR appear to be the most relevant prognostic measures of systemic inflammatory response. They may be used as an adjunct for patient counseling, tailoring management and clinical trial design.
Collapse
Affiliation(s)
- Ilaria Lucca
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - Michela de Martino
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sebastian L Hofbauer
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Nura Zamani
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Tobias Klatte
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
34
|
Serum and urine biomarkers for human renal cell carcinoma. DISEASE MARKERS 2015; 2015:251403. [PMID: 25922552 PMCID: PMC4398943 DOI: 10.1155/2015/251403] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/26/2015] [Indexed: 12/16/2022]
Abstract
Renal cell carcinoma (RCC) diagnosis is mostly achieved incidentally by imaging provided for unrelated clinical reasons. The surgical management of localized tumors has reported excellent results. The therapy of advanced RCC has evolved considerably over recent years with the widespread use of the so-called “targeted therapies.” The identification of molecular markers in body fluids (e.g., sera and urine), which can be used for screening, diagnosis, follow-up, and monitoring of drug-based therapy in RCC patients, is one of the most ambitious challenges in oncologic research. Although there are some promising reports about potential biomarkers in sera, there is limited available data regarding urine markers for RCC. The following review reports some of the most promising biomarkers identified in the biological fluids of RCC patients.
Collapse
|
35
|
Omae K, Kondo T, Tanabe K. High preoperative C-reactive protein values predict poor survival in patients on chronic hemodialysis undergoing nephrectomy for renal cancer. Urol Oncol 2015; 33:67.e9-13. [DOI: 10.1016/j.urolonc.2014.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 07/11/2014] [Indexed: 11/30/2022]
|
36
|
Prognostic significance of host immune status in patients with late relapsing renal cell carcinoma treated with targeted therapy. Target Oncol 2015; 10:517-22. [PMID: 25559290 DOI: 10.1007/s11523-014-0356-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/18/2014] [Indexed: 02/07/2023]
Abstract
We aimed to assess the prognostic role of pretreatment neutrophilia, lymphocytopenia, and neutrophil to lymphocyte ratio (NLR) in patients treated with vascular endothelial growth factor-tyrosine kinase inhibitors (VEGFR-TKIs) for late relapsing (>5 years) metastatic renal cell carcinoma (mRCC). Data were collected from 13 Italian centers involved in the treatment of metastatic RCC. Late relapse was defined as >5 years after initial radical nephrectomy. One hundred fifty-one patients were included in this analysis. Among them, MSKCC risk score was favorable in 68 %, intermediate in 29 %, and poor in 3 %. Fifty-six patients (37 %) had NLR ≥3 at the start of VEGFR-TKI therapy (group A), while 95 had lower NLR (63 %, group B). The median overall survival (OS) was 28.8 months in group A and 68.7 months (95 % confidence interval (CI) 45.3-NA) in group B (p < 0.001). The median progression-free survival (PFS) was 15.8 months in group A and 25.1 months in group B (p = 0.03). At multivariate analysis, MSKCC risk group and NLR were independent prognostic factors for both OS and PFS. Pretreatment NLR is an independent prognostic factor for patients with late relapsing mRCC treated with first-line VEGFR-TKIs. A better characterization of baseline immunological impairment may optimize the management of this RCC subpopulation.
Collapse
|
37
|
Czarnecka AM, Kukwa W, Kornakiewicz A, Lian F, Szczylik C. Clinical and molecular prognostic and predictive biomarkers in clear cell renal cell cancer. Future Oncol 2014; 10:2493-508. [DOI: 10.2217/fon.14.162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
ABSTRACT The natural history of clear cell renal cell cancer is highly unpredictable with various progressors and with populations where small renal masses may be accompanied by metastatic disease. Currently, there is a critical need to determine patient risk and optimize treatment regimes. For these patients, molecular markers may offer significant information in terms of prognostic and predictive values, as well as determination of valid therapeutic targets. Until now, only a few of the many identified clear cell renal cell cancer biomarkers have been clinically validated in large cohorts. And only several biomarkers are integrated in predictive or prognostic models. Therefore, a large cohesive effort is required to advance the field of clear cell renal cell cancer prognostic biomarkers through systematic discovery, verification, validation and clinical implementation.
Collapse
Affiliation(s)
- Anna M Czarnecka
- Department of Oncology with Laboratory of Molecular Oncology, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Wojciech Kukwa
- Department of Otolaryngology, Czerniakowski Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Anna Kornakiewicz
- Department of Oncology with Laboratory of Molecular Oncology, Military Institute of Medicine, 04-141 Warsaw, Poland
- Postgraduate School of Molecular Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Fei Lian
- Department of Urology, Emory School of Medicine, Atlanta, GA, USA
| | - Cezary Szczylik
- Department of Oncology with Laboratory of Molecular Oncology, Military Institute of Medicine, 04-141 Warsaw, Poland
| |
Collapse
|
38
|
Kheifetz Y, Elishmereni M, Agur Z. Complex pattern of interleukin-11-induced inflammation revealed by mathematically modeling the dynamics of C-reactive protein. J Pharmacokinet Pharmacodyn 2014; 41:479-91. [PMID: 25231819 DOI: 10.1007/s10928-014-9383-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 09/06/2014] [Indexed: 11/25/2022]
Abstract
Inflammation underlies many diseases and is an undesired effect of several therapy modalities. Biomathematical modeling can help unravel the complex inflammatory processes and the mechanisms triggering their emergence. We developed a model for induction of C-reactive protein (CRP), a clinically reliable marker of inflammation, by interleukin (IL)-11, an approved cytokine for treatment of chemotherapy-induced thrombocytopenia. Due to paucity of information on the mechanisms underlying inflammation-induced CRP dynamics, our model was developed by systematically evaluating several models for their ability to retrieve variable CRP profiles observed in IL-11-treated breast cancer patients. The preliminary semi-mechanistic models were designed by non-linear mixed-effects modeling, and were evaluated by various performance criteria, which test goodness-of-fit, parsimony and uniqueness. The best-performing model, a robust population model with minimal inter-individual variability, uncovers new aspects of inflammation dynamics. It shows that CRP clearance is a nonlinear self-controlled process, indicating an adaptive anti-inflammatory reaction in humans. The model also reveals a dual IL-11 effect on CRP elevation, whereby the drug has not only a potent immediate influence on CRP incline, but also a long-term influence inducing elevated CRP levels for several months. Consistent with this, model simulations suggest that periodic IL-11 therapy may result in prolonged low-grade (chronic) inflammation post treatment. Future application of the model can therefore help design improved IL-11 regimens with minimized long-term CRP toxicity. Our study illuminates the dynamics of inflammation and its control, and provides a prototype for progressive modeling of complex biological processes in the medical realm and beyond.
Collapse
Affiliation(s)
- Yuri Kheifetz
- Institute for Medical Biomathematics (IMBM), POB 282, Hate'ena St. 10, 60991, Bene-Ataroth, Israel
| | | | | |
Collapse
|
39
|
Ha YS, Lee GT, Kim YH, Kwon SY, Choi SH, Kim TH, Kwon TG, Yun SJ, Kim IY, Kim WJ. Decreased selenium-binding protein 1 mRNA expression is associated with poor prognosis in renal cell carcinoma. World J Surg Oncol 2014; 12:288. [PMID: 25227434 PMCID: PMC4176564 DOI: 10.1186/1477-7819-12-288] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/02/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The anticancer effects of selenium may be mediated by selenium-binding proteins, such as SELENBP1. The association between SELENBP1 expression levels and clinicopathologic parameters was assessed in renal cell carcinoma (RCC). METHODS SELENBP1 mRNA expression was measured with real-time quantitative polymerase chain reaction (qPCR) in 139 specimens of primary RCC and 59 specimens of donor-matched normal-appearing kidney tissues. The prognostic effect of SELENBP1 levels was evaluated with Kaplan-Meier and multivariate Cox regression analyses. RESULTS SELENBP1 mRNA levels were significantly lower in tumor tissues than in matched normal kidney tissues (P < 0.001) and significantly inversely correlated with pathologic (T-stage and Fuhrman grade) and prognostic variables (progression and cancer-specific death). Kaplan-Meier estimates showed that low SELENBP1 expression was significantly correlated with cancer-specific death (log-rank test, P = 0.014), and a multivariate Cox regression model revealed that SELENBP1 expression was an independent predictor of cancer-specific death (HR, 0.111; P = 0.006). CONCLUSIONS SELENBP1 might play a role in tumor suppression and could be a useful prognostic factor in RCC.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Wun-Jae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea.
| |
Collapse
|
40
|
Pretherapeutic gamma-glutamyltransferase is an independent prognostic factor for patients with renal cell carcinoma. Br J Cancer 2014; 111:1526-31. [PMID: 25117808 PMCID: PMC4200090 DOI: 10.1038/bjc.2014.450] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/13/2014] [Accepted: 07/15/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Gamma-glutamyltransferase (GGT) regulates apoptotic balance and promotes cancer progression and invasion. Higher pretherapeutic GGT serum levels have been associated with worse outcomes in various malignancies, but there are no data for renal cell carcinoma (RCC). METHODS Pretherapeutic GGT serum levels and clinicopathological parameters were retrospectively evaluated in 921 consecutive RCC patients treated with nephrectomy at a single institution between 1998 and 2013. Gamma-glutamyltransferase was analysed as continuous and categorical variable. Associations with RCC-specific survival were assessed with Cox proportional hazards models. Discrimination was measured with the C-index. Decision-curve analysis was used to evaluate the clinical net benefit. The median postoperative follow-up was 45 months. RESULTS Median pretherapeutic serum GGT level was 25 U l(-1). Gamma-glutamyltransferase levels increased with advancing T (P<0.001), N (P=0.006) and M stages (P<0.001), higher grades (P<0.001), and presence of tumour necrosis (P<0.001). An increase of GGT by 10 U l(-1) was associated with an increase in the risk of death from RCC by 4% (HR 1.04, P<0.001). Based on recursive partitioning-based survival tree analysis, we defined four prognostic categories of GGT: normal low (<17.5 U l(-1)), normal high (17.5 to <34.5 U l(-1)), elevated (34.5 to <181.5 U l(-1)), and highly elevated (⩾181.5 U l(-1)). In multivariable analyses that adjusted for the effect of standard features, both continuously and categorically coded GGT were independent prognostic factors. Adding GGT to a model that included standard features increased the discrimination by 0.9% to 1.8% and improved the clinical net benefit. CONCLUSIONS Pretherapeutic serum GGT is a novel and independent prognostic factor for patients with RCC. Stratifying patients into prognostic subgroups according to GGT may be used for patient counselling, tailoring surveillance, individualised treatment planning, and clinical trial design.
Collapse
|
41
|
de Martino M, Leitner CV, Seemann C, Hofbauer SL, Lucca I, Haitel A, Shariat SF, Klatte T. Preoperative serum cholesterol is an independent prognostic factor for patients with renal cell carcinoma (RCC). BJU Int 2014; 115:397-404. [PMID: 24698164 DOI: 10.1111/bju.12767] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the prognostic role of preoperative serum cholesterol in patients with renal cell carcinoma (RCC), as increasing evidence suggests that alterations in the lipid profile are associated with the development, progression and prognosis of various cancers. PATIENTS AND METHODS We analysed 867 patients, who underwent radical or partial nephrectomy for RCC between 2002 and 2012. Preoperative total cholesterol levels were determined in serum using colorimetric analysis (CHOD-PAP method). The association with cancer-specific survival (CSS) was assessed with Cox models. Discrimination was quantified with the C-index. The median follow-up was 52 months. RESULTS The median (interquartile range) serum cholesterol was 195 (166-232) mg/dL. Decreasing serum cholesterol was associated with more advanced T, N and M stages (P < 0.001), higher grades (P = 0.001) and presence of tumour necrosis (P = 0.002). Continuously coded cholesterol was associated with CSS in both univariable (hazard ratio [HR] 0.87, P < 0.001) and multivariable analyses (HR 0.93, P = 0.001). The discrimination of a multivariable base model increased significantly from 88.3% to 89.2% following inclusion of cholesterol (P = 0.006). In patients with clinically localised disease (T1-3N0/+M0), cholesterol remained associated with CSS in multivariable analysis (HR 0.90, P = 0.002) and increased the discrimination from 74.6% to 76.9% (P = 0.002). CONCLUSIONS Preoperative serum cholesterol is an independent prognostic factor for patients with RCC, with lower levels being associated with worse survival. Its use increases the discrimination of established prognostic factors. As cholesterol is a broadly available routine marker, its use may provide a meaningful adjunct in clinical practice. The biological rationale underlying this association remains to be clarified.
Collapse
Affiliation(s)
- Michela de Martino
- Department of Urology, Comprehensive Cancer Center of the Medical University of Vienna
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Yi JH, Wang D, Li ZY, Hu J, Niu XF, Liu XL. C-reactive protein as a prognostic factor for human osteosarcoma: a meta-analysis and literature review. PLoS One 2014; 9:e94632. [PMID: 24800842 PMCID: PMC4011684 DOI: 10.1371/journal.pone.0094632] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/19/2014] [Indexed: 12/12/2022] Open
Abstract
Background Osteosarcoma is the most common primary bone cancer in growing adolescents and young adults. The prognostic role of C-reactive protein (CRP) in patients with osteosarcoma is not fully investigated. The purpose of this study is to perform a meta-analysis and literature review on the role of CRP in osteosarcoma and to assess the potential role of serum CRP as a prognostic factor for patients with osteosarcoma. Methods A detailed literature search was made in Medline for related research publications written in English. Methodological quality of the studies was also evaluated. The data were extracted and assessed by two reviewers independently. Analysis of pooled data were performed, risk ratio (RR) and corresponding confidence intervals (CIs) were calculated and summarized respectively. Results Final analysis of 397 patients from 2 eligible studies was performed. Combined RR of CRP expression suggested that the raised serum CRP level had an adverse prognostic effect on overall survival of patients with osteosarcoma (n = 397 in 2 studies; RR = 0.35; 95% CI: 0.18–0.68; p = 0.002). In the uni- and multivariate survival analysis, response rate and CRP levels were the only independent prognostic variables. Conclusions The results of this meta-analysis suggest that CRP expression confers a worse prognosis in patients with osteosarcoma. Large prospective studies are necessary to provide solid data to confirm the prognostic significance of CRP.
Collapse
Affiliation(s)
- Jian-Hua Yi
- The Upper Limb Orthopedic Department of Huang Pu Award, The First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China
| | - Dong Wang
- The Upper Limb Orthopedic Department of Huang Pu Award, The First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China
| | - Zhi-Yong Li
- The Upper Limb Orthopedic Department of Huang Pu Award, The First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China
- * E-mail:
| | - Jun Hu
- The Upper Limb Orthopedic Department of Huang Pu Award, The First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China
| | - Xiao-Feng Niu
- The Upper Limb Orthopedic Department of Huang Pu Award, The First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China
| | - Xiao-Lin Liu
- The Upper Limb Orthopedic Department of Huang Pu Award, The First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China
| |
Collapse
|
43
|
Dai J, Tang K, Xiao W, Yu G, Zeng J, Li W, Zhang YQ, Xu H, Chen ZQ, Ye ZQ. Prognostic Significance of C-reactive Protein in Urological Cancers: a Systematic Review and Meta-analysis. Asian Pac J Cancer Prev 2014; 15:3369-75. [DOI: 10.7314/apjcp.2014.15.8.3369] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
44
|
Ngo TC, Wood CG, Karam JA. Biomarkers of renal cell carcinoma. Urol Oncol 2014; 32:243-51. [DOI: 10.1016/j.urolonc.2013.07.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/15/2013] [Accepted: 07/17/2013] [Indexed: 12/13/2022]
|
45
|
Neutrophil-lymphocyte ratio in small renal masses. ISRN UROLOGY 2014; 2014:759253. [PMID: 25006517 PMCID: PMC3972910 DOI: 10.1155/2014/759253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 02/27/2014] [Indexed: 12/18/2022]
Abstract
Introduction. To evaluate the association between preoperative neutrophil-lymphocyte ratio (NLR) and clinicopathologic characteristics in patients with small renal masses (SRM). Methods. Retrospective chart reviews of patients with renal masses ≤4 cm who underwent nephrectomy from January 2007 to July 2012 were conducted. Multivariable linear regression was used to examine the association between preoperative NLR and clinicopathologic variables. Results. In 1001 patients, we noted higher mean preoperative NLR in men (3.0 ± 1.4 versus 2.6 ± 1.3 in women, P < 0.01) and Caucasians (2.9 ± 1.4 versus 1.9 ± 0.9 in African Americans, P < 0.01) but no significant differences in patients with low (I-II) versus high (III-IV) American Society of Anesthesiologists (ASA) scores (2.8 ± 1.4 versus 2.9 ± 1.5, P = 0.18) or benign versus malignant pathology (2.9 ± 1.4 versus 2.8 ± 1.3, P = 0.75). Spearman correlation analysis (ρ) showed preoperative NLR significantly correlated with age (ρ = 0.15, P < 0.01) and preoperative serum creatinine (Crea) [ρ = 0.13, P < 0.01]. On multivariable linear regression analysis older age, male gender, Caucasian race, and preoperative Crea were predictive of higher preoperative NLR, but ASA score and tumor pathology were not. Conclusions. In patients with SRM, we found no association between preoperative NLR and tumor pathology.
Collapse
|
46
|
Preoperative butyrylcholinesterase level as an independent predictor of overall survival in clear cell renal cell carcinoma patients treated with nephrectomy. ScientificWorldJournal 2014; 2014:948305. [PMID: 24741368 PMCID: PMC3972832 DOI: 10.1155/2014/948305] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 01/29/2014] [Indexed: 11/17/2022] Open
Abstract
The prognostic factors for the overall survival (OS) of clear cell renal cell carcinoma (ccRCC) patients treated with nephrectomy are not well defined. In the present study, we investigated the prognostic significance of preoperative butyrylcholinesterase (BChE) levels in 400 ccRCC patients undergoing radical or partial nephrectomy from 1992 to 2013 at our institution. Univariate and multivariate analyses were performed to determine the clinical factors associated with OS. Among the enrolled patients, 302 were diagnosed with organ-confined disease only (T1-2N0M0), 16 with lymph node metastases, and 56 with distant metastases. The median preoperative BChE level was 250 U/L (normal range, 168-470 U/L), and median follow-up period was 36 months. The 3-year OS rate in patients with preoperative BChE levels of ≥100 U/L was significantly higher than in those with levels of <100 U/L (89.3% versus 77.7%, P = 0.004). On univariate analysis, performance status; anemia; hypoalbuminemia; preoperative levels of BChE, corrected calcium, and C-reactive protein; and distant metastasis status were significantly associated with OS. Multivariate analysis revealed that preoperative BChE levels and distant metastasis status were significantly associated with OS. Our findings suggest a possible role of preoperative BChE levels as an independent predictor of OS after nephrectomy in ccRCC patients.
Collapse
|
47
|
Diagnostic and prognostic role of preoperative circulating CA 15-3, CA 125, and beta-2 microglobulin in renal cell carcinoma. DISEASE MARKERS 2014; 2014:689795. [PMID: 24692843 PMCID: PMC3947895 DOI: 10.1155/2014/689795] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 12/01/2013] [Accepted: 01/02/2014] [Indexed: 12/28/2022]
Abstract
CA 15-3, CA 125 and β-2 microglobulin are three common tumor markers currently used for diagnosis, prognosis, assessment of therapeutic response, and/or to evaluate recurrence in breast and ovarian cancer and malignant lymphoproliferative disorders, respectively. In the present prospective study we assessed the role of these three serum proteins as biomarkers for renal cell carcinoma (RCC), as well as any association between tumor marker levels and clinical-pathological parameters. CA 15-3, CA 125, and β-2 microglobulin were preoperatively measured in 332 patients who underwent nephrectomy for RCC. Estimates of cancer-specific survival (CSS) was calculated according to the Kaplan-Meier method. Multivariate analysis was performed to identify the most significant variables for predicting CSS. Preoperatively, 35.2% (n = 117), 9.6% (n = 32) and 30.4% (n = 101) of the patients had abnormal levels of CA 15-3, CA 125 and β-2 microglobulin, respectively. Statistically significant differences resulted between CA 15-3, CA 125 and β-2 microglobulin values and tumor size, Fuhrman grade, presence of lymph node, and visceral metastases. CSS was significantly decreased for patients with high levels of CA 15-3, CA 125, and β-2 microglobulin (P < 0.0001, P < 0.0001, and P = 0.001, resp.). At multivariate analysis only age, the presence of visceral metastases, and high levels of CA 15-3 were independent adverse prognostic factors for CSS.
Collapse
|
48
|
de Martino M, Waldert M, Haitel A, Schatzl G, Shariat SF, Klatte T. Evaluation of ABO blood group as a prognostic marker in renal cell carcinoma (RCC). BJU Int 2013; 113:E62-6. [PMID: 24053513 DOI: 10.1111/bju.12436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate ABO blood group as a prognostic marker in patients with renal cell carcinoma (RCC). PATIENTS AND METHODS This retrospective study included 556 consecutive patients who underwent surgery for RCC at a single institution. The associations of ABO blood group with clinical and pathological variables were assessed using Kruskal-Wallis and chi-squared tests. The impact on overall survival (OS) and RCC-specific survival (RCC-SS) was analysed using univariable and multivariable Cox proportional hazards regression models. RESULTS Blood group O was associated with the absence of lymph node metastases (P = 0.034) and the presence of bilateral RCC (P = 0.017). No associations with age, gender, body mass index, Charlson comorbidity index, T stage, M stage, grade and histological subtype were observed. In univariable and multivariable survival analysis, ABO blood group was not associated with OS and RCC-SS. CONCLUSIONS In the present study, ABO blood group was not linked with RCC prognosis. Blood group O may be associated with the absence of lymph node metastases and the presence of bilateral RCC. External validation in larger cohorts is necessary.
Collapse
|
49
|
Pre-treatment neutrophil-to-lymphocyte ratio may be associated with the outcome in patients treated with everolimus for metastatic renal cell carcinoma. Br J Cancer 2013; 109:1755-9. [PMID: 24008663 PMCID: PMC3790174 DOI: 10.1038/bjc.2013.522] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 08/06/2013] [Accepted: 08/09/2013] [Indexed: 12/12/2022] Open
Abstract
Background: Everolimus is a mammalian target of rapamycin inhibitor approved for the treatment of metastatic renal cell carcinoma (mRCC). We aimed to assess the association between pre-treatment neutrophil-to-lymphocyte ratio (NLR) and the outcome of patients treated with everolimus for mRCC. Methods: Ninety-seven patients with mRCC were treated with everolimus till April 2013 in our institutions. Patients were stratified in two groups with NLR >3 (Group A) vs <3 (Group B). Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan–Meier method. Gender, age, Motzer prognostic group, PFS on first-line therapy, neutrophilia and NLR were included in the Cox analysis to investigate their prognostic relevance. Results: Median OS and PFS were 10.6 and 5.3 months, respectively. Median OS was 12.2 months in Group A and 24.4 months in Group B (P=0.001). Median PFS was 3.4 months in Group A and 9.9 months in Group B (P<0.001). At multivariate analysis, only Motzer prognostic group and NLR were independent prognostic factors for OS and PFS. Conclusion: Pre-treatment NLR is an independent prognostic factor for patients with mRCC treated with second- or third-line everolimus. This should be investigated and validated in prospective studies.
Collapse
|
50
|
de Martino M, Pantuck AJ, Hofbauer S, Waldert M, Shariat SF, Belldegrun AS, Klatte T. Prognostic impact of preoperative neutrophil-to-lymphocyte ratio in localized nonclear cell renal cell carcinoma. J Urol 2013; 190:1999-2004. [PMID: 23831313 DOI: 10.1016/j.juro.2013.06.082] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 01/31/2023]
Abstract
PURPOSE The preoperative neutrophil-to-lymphocyte ratio was proposed as a prognostic factor for localized clear cell renal cell carcinoma. We evaluated its role in nonclear cell renal cell carcinoma. MATERIALS AND METHODS We queried 2 prospective kidney cancer databases. Patients who underwent full resection of localized (T1-3 N0/+ M0) nonclear cell renal cell carcinoma by radical or partial nephrectomy were included in analysis. Associations of the continuously coded neutrophil-to-lymphocyte ratio with disease-free survival were assessed with univariable and multivariable Cox regression models. Prognostic accuracy was evaluated with the Harrell concordance index. RESULTS Our final cohort included 281 patients. The 5-year disease-free survival rate was 88.1%. The neutrophil-to-lymphocyte ratio was significantly associated with disease-free survival. With each 1.0 increase in the ratio the risk of recurrence increased by 15% (HR 1.15, p=0.028). On multivariable analysis TNM group (HR 2.84, p=0.025), Fuhrman grade (HR 3.40, p<0.001) and the neutrophil-to-lymphocyte ratio (HR 1.17, p=0.022) were independently associated with disease-free survival. Adding the neutrophil-to-lymphocyte ratio improved the accuracy of a base model to predict disease-free survival from 78.8% to 80.8%. CONCLUSIONS The neutrophil-to-lymphocyte ratio is an independent prognostic factor for disease-free survival after surgery with curative intent for localized nonclear cell renal cell carcinoma. It significantly increases the accuracy of established prognostic factors. The neutrophil-to-lymphocyte ratio may provide a meaningful adjunct for patient counseling and clinical trial design.
Collapse
Affiliation(s)
- Michela de Martino
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, University of California-Los Angeles (AJP, ASB), Los Angeles, California
| | | | | | | | | | | | | |
Collapse
|