Preoperative neutrophil-to-lymphocyte ratio predicts the surgical outcome of Xp11.2 translocation/TFE3 renal cell carcinoma patients

Clinical value of combined preoperative-postoperative neutrophil-to-lymphocyte ratio in predicting hepatocellular carcinoma prognosis after radiofrequency ablation

OBJECTIVE

Previous studies focused on the prognostic significance of the pre- or post-operative neutrophil-lymphocyte ratio (NLR); the significance of combined pre- and post-operative NLR (PP-NLR) remains unknown. Therefore, we investigated the value of PP-NLR for predicting prognosis after radiofrequency ablation (RFA) in patients with hepatocellular carcinoma (HCC) to improve treatment and prolong survival.

METHODS

We investigated pre- and post-operative NLR and PP-NLR in predicting prognosis after RFA in patients with HCC. Optimal thresholds for leukocytes, lymphocytes, neutrophils, and NLR before and after RFA were retrospectively assessed in patients with HCC who had undergone RFA between January 2018 and June 2019 in Harbin Medical University Cancer Hospital. Risk factors for early HCC recurrence and those affecting recurrence-free survival (RFS) were analyzed.

RESULTS

The respective pre- and post-operative optimal thresholds were as follows: neutrophils, 3.431 and 4.975; leukocytes, 5.575 and 6.61; lymphocytes, 1.455 and 1.025; and NLR, 1.53 and 4.36. Univariate analysis revealed tumor number; alpha-fetoprotein level; post-operative leukocytes, lymphocytes, NLR, and neutrophils; pre-operative neutrophils and NLR; and PP-NLR as factors influencing early recurrence and RFS. Multivariate analysis indicated PP-NLR as an independent risk factor for poor RFS and early recurrence.

CONCLUSION

PP-NLR was more effective for predicting prognosis than pre- or post-operative NLR alone for patients with HCC.

ADVANCES IN KNOWLEDGE

The novelty of this study lies in the combination of pre- and post-operative NLR, namely PP-NLR, to study its prognostic value for HCC patients after RFA, which has not been found in previous studies. The contribution of our study is that PP-NLR can provide clinicians with a new reference index to judge the prognosis of patients and make timely treatment to help patients improve their prognosis.

Prognostic Role of Pretreatment C-Reactive Protein to Albumin Ratio in Urological Cancers: A Systematic Review and Meta-Analysis

Background

To investigate the potential prognostic role of C-reactive protein to albumin ratio (CAR) in patients with urinary cancers, including renal cell carcinoma (RCC), bladder cancer (BC), and prostate cancer (PC).

Methods

We searched and screened literatures with PubMed, Embase, Cochrane Library, and Web of Science in January 2022. We applied combined hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the associations.

Results

Thirteen studies including 2,941 cases were analyzed in our study. Merged results indicated that highly pretreated CAR was associated with inferior overall survival (HR 2.21, 95% CI 1.86-2.62, p < 0.001) and progression-free survival (HR 1.85, 95% CI 1.36-2.52, p < 0.001) for urinary cancers. In a subgroup analysis of OS by tumor type, CAR can be a predictor in RCC (HR 2.10, 95% CI 1.72-2.56), BC (HR 3.35, 95% CI 1.94-5.80), and PC (HR 2.20, 95% CI 1.43-3.37). In a subgroup analysis of PFS by tumor type, CAR can be a predictor in BC (HR 1.76, 95% CI 1.03-3.02), and RCC (HR 1.90, 95% CI 1.25-2.89). The reliability and robustness of results were confirmed.

Conclusions

High pretreated CAR was effective predictor of poor survival in patients with urinary cancers and can act as prognostic factor for these cases.

Systematic Review Registration

PROSPERO (CRD42022306414).

A meta-analysis of the platelet-lymphocyte ratio: A notable prognostic factor in renal cell carcinoma

BACKGROUND

The platelet-lymphocyte ratio (PLR) has been assessed in some studies on renal cell carcinoma (RCC), but the results have been inconsistent. This meta-analysis aims to review and report the latest data regarding the prognostic role of the PLR in RCC patients.

METHOD

Articles were searched in the PubMed, EMBASE, and Cochrane Library electronic databases. Studies were filtered according to a selection strategy, and data corresponding to the index of interest were extracted. A fixed-effects model or random-effects model was selected based on heterogeneity. The sensitivity analysis was carried out by eliminating the studies one by one. Finally, funnel plots and Egger's test were used to assess publication bias, and the trim and fill method was used to assess the impact of bias on the results.

RESULTS

In total, 15,193 patients with RCC from 44 studies were included in this meta-analysis. The pooled analysis indicated that the higher the PLR was, the poorer the prognosis for RCC patients in terms of overall survival (hazard ratio (HR) = 1.01 (95% confidence interval (CI) 1.00, 1.02), P = 0.010), cancer-special survival (CSS) (HR = 1.21 (95% CI 1.00, 1.46), P = 0.05), progression-free survival (HR = 1.44 (95% CI 1.28, 1.62), P < 0.00001), recurrence-free survival (HR = 1.73 (95% CI 1.11, 2.71), P = 0.02), disease-free survival (HR = 1.63 (95% CI 0.91, 2.94), P = 0.01) and metastasis-free survival (HR = 1.223 (95% CI 0.712, 2.099), P = 0.466). In the subgroup analysis of high PLR, targeted treatment, TKI use, nivolumab use, surgical treatment, clear cell RCC, metastasis, Asian race, and high PLR were related to poor prognosis.

CONCLUSION

This study showed that a high PLR was associated with the poor prognosis of RCC patients, but more studies are needed to confirm the value of the PLR.

Prognostic Significance of NLR About NETosis and Lymphocytes Perturbations in Localized Renal Cell Carcinoma With Tumor Thrombus

Background

Non-metastatic renal cell carcinoma (RCC) with tumor thrombus showed a greater tendency for developing metastases after surgery. Early identification of patients with high risk of poor prognosis is especially important to explore adjuvant treatment of improving outcomes. Neutrophil-to-lymphocyte ratio (NLR) was a systemic inflammation marker and outcome predictor in RCC, reflecting the chaos in systemic immune status in cancer as myeloid cell expansion and lymphatic cell suppression. Neutrophil extracellular traps (NET) formation (NETosis) is the process of neutrophils generating an extracellular DNA net-like structure. NETosis in tumor was demonstrated to conduce to the subsequent metastases of tumor. However, the role of NLR for systemic immune status and tumor local immune infiltration, especially for neutrophil-associated NETs, in non-metastatic RCC with thrombus remains unclear.

Patients and Methods

In our clinical cohort, we enrolled the clinical, pathologic, and preoperative laboratory parameters of 214 RCC patients with tumor thrombus who were treated surgically. The clinical endpoint was defined as cancer-specific survival (CSS). In our basic research cohort, RNA-seq, TCR-seq, and scRNA-seq data were analyzed. Patients who reached the endpoint as recurrence-free survival (RFS) were defined as the “High-risk” group. Otherwise, they were separated into the “Low-risk” group.

Results

In the clinical cohort, NLR≥4 was an independent risk factor for 203 localized RCC with tumor thrombus. In the basic research cohort, tumor thrombi were separated into NETosis-thrombi belonging to the “High-risk” group and non-NETosis-thrombi to the “Low-risk” group. NETs induced by tumor-derived G-CSF in tumor thrombus has a mechanistic role in unfavorable prognosis. Besides, NETs-score from single sample GSEA (ssGSEA) algorithm was an independent prognostic factor validated in the TCGA data. Apart from the neutrophils-associated NETosis, systemic immune perturbations of lymphocytes occurred in the “High-risk” group, represented with decreased TCR diversity and increasingly high proportion of CD4-positive effector memory T (Tem) cells, which indirectly represented the state of lymphopenia.

Conclusions

Our findings firstly demonstrated that neutrophils-associated NETosis and systemic lymphocytes perturbations were considered as tumor progression in patients of localized RCC with tumor thrombus, which reflected NLR≥4 as an independent risk factor for patients.

Xp11.2 Translocation Renal Cell Carcinoma: Clinical Characteristics and Potential Prognostic Predictors

Background

Xp11.2 translocation renal cell carcinoma, a rare malignancy, has a higher prevalence in children than in adults. It is relatively indolent in children but manifests with an aggressive course in adults. Clinical characteristics and prognostic studies for adult patients are scarce due to its rarity.

Methods

This retrospective single-center study consecutively enrolled 24 newly diagnosed Xp11.2 translocation RCC adult patients. Clinical presentations were recorded, and baseline laboratory results and follow-up data were collected. Possible risk factors for progression-free survival and overall survival were first scanned with chi-square tests and t-tests to compare patients who suffered from progression or death with who did not. Multivariate Cox regression was further utilized to identify independent risk factors.

Results

Twenty-four adult patients (median age 32, range 16-73), with a male-to-female ratio of 1 : 1, was included from April 2010 to March 2020. After follow-up for 35.7 months (+/- months), seven patients died. With univariate analysis, higher C-reactive protein-to-albumin (CRP/Alb) ratio (p = 0.028), higher baseline fibrinogen (p = 0.006), and presence of distant metastasis (p = 0.007) were associated with progression of the disease; higher preoperative fibrinogen (p = 0.014) and distant metastasis (p = 0.020) were associated with death. With multivariate Cox regression, only baseline fibrinogen level (p = 0.001) was identified as an independent risk factor for progression-free survival; meanwhile, fibrinogen level (p = 0.048) and distant metastasis (p = 0.043) were identified as independent risk factors for survival.

Conclusions

Overall, relatively high CRP/Alb ratios, fibrinogen, and distant metastasis were associated with a poor prognosis of Xp11.2 tRCC adult patients; among them, only baseline fibrinogen levels independently predicted the progression of Xp11.2 tRCC; thus, it may help to identify patients with worse progression or death risk.

Factors Associated with Survival From Xp11.2 Translocation Renal Cell Carcinoma Diagnosis-A Systematic Review and Pooled Analysis

Purpose: Xp11.2 translocation renal cell carcinoma (Xp11.2 tRCC) is a rare subtype of renal cell carcinoma (RCC), characterized by translocations of Xp11.2 breakpoints, involving of the transcription factor three gene (TFE3). The aim of our study was to comprehensively characterize the clinical characteristics and outcomes, and to identify risk factors associated with OS and PFS in Xp11.2 tRCC patients.

Methods: Literature search on Xp11.2 tRCC was performed using databases such as pubmed EMBASE and Web of Science. Studies were eligible if outcomes data (OS and/or PFS) were reported for patients with a histopathologically confirmed Xp11.2 tRCC. PFS and OS were evaluated using the univariable and multivariable Cox regression model.

Results: There were 80 eligible publications, contributing 415 patients. In multivariable analyses, the T stage at presentation was significantly associated with PFS (HR: 3.87; 95% CI: 1.70 to 8.84; p = 0.001). The median time of PFS was 72 months. In the multivariable analyses, age at diagnosis (HR: 2.16; 95% CI: 1.03 to 4.50; p = 0.041), T stage at presentation (HR: 4.44; 95% CI: 2.16 to 9.09; p < 0.001) and metastasis status at presentation (HR: 2.67; 95% CI: 1.12 to 6.41; p = 0.027) were all associated with OS, with a median follow-up time of 198 months.

Conclusion: T stage at presentation is the only factor that is associated with both PFS and OS in patients with Xp11.2 tRCC. Also, patients over 45 or with metastases are more likely to have poorer OS.

Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor of Disease-free Survival in Postnephrectomy High-risk Locoregional Renal Cell Carcinoma: Analysis of the S-TRAC Trial

PURPOSE

In the S-TRAC trial, adjuvant sunitinib improved disease-free survival (DFS) compared with placebo in patients with locoregional renal cell carcinoma (RCC) at high risk of recurrence. This post hoc exploratory analysis investigated the neutrophil-to-lymphocyte ratio (NLR) for predictive and prognostic significance in the RCC adjuvant setting.

EXPERIMENTAL DESIGN

Kaplan-Meier estimates and Cox proportional analyses were performed on baseline NLR and change from baseline at week 4 to assess their association with DFS. Univariate P values were two-sided and based on an unstratified log-rank test.

RESULTS

609 of 615 patients had baseline NLR values; 574 patients had baseline and week 4 values. Sunitinib-treated patients with baseline NLR <3 had longer DFS versus placebo (7.1 vs. 4.7; HR, 0.71; P = 0.02). For baseline NLR ≥3, DFS was similar regardless of treatment (sunitinib 6.8 vs. placebo not reached; HR, 1.03; P = 0.91). A ≥25% NLR decrease at week 4 was associated with longer DFS versus no change (6.8 vs. 5.3 years; HR, 0.71; P = 0.01). A greater proportion of sunitinib-treated patients had ≥25% NLR decrease at week 4 (71.2%) versus placebo (17.4%). Patients with ≥25% NLR decrease at week 4 received a higher median cumulative sunitinib dose (10,137.5 mg) versus no change (8,168.8 mg) or ≥25% increase (6,712.5 mg).

CONCLUSIONS

In the postnephrectomy high-risk RCC patient cohort, low baseline NLR may help identify those most suitable for adjuvant sunitinib. A ≥25% NLR decrease at week 4 may be an early indicator of those most likely to tolerate treatment and derive DFS benefit.

C-reactive protein to albumin ratio predicts the outcome in renal cell carcinoma: A meta-analysis

Background

Growing evidence has revealed that pretreatment C-reactive protein to albumin ratio (CAR) are associated with prognosis for patients with renal cell carcinoma (RCC). However, inconsistent findings have been reported, which promote us to summarize the global predicting role of CAR for survival in RCC patients.

Methods

Two reviewers independently retrieved the literature on EMBASE, MEDLINE, and Cochrane Library databases for eligible studies evaluating the associations of CAR with survival. Data related to the overall survival (OS), disease-free survival (DFS), progress-free survival (PFS), and clinicopathological features were extracted and pooled using meta-analysis with fixed or random- effect models when applicable.

Results

Eight studies including 2,829 patients were analyzed in the present study. High pretreatment CAR was associated with worse OS (pooled HR: 2.14, 95% CI = 1.64–2.79, p < 0.001) and DFS/PFS (pooled HR: 1.75, 95% CI: 1.31–2.35, P < 0.001). Moreover, high CAR was correlated with performance status (≥ 1), tumor location (left), Fuhrman grade (3–4), TNM stage (III-IV), T stage (T3-4), N stage (N1), M stage (M1), tumor necrosis (yes), venous thrombus (positive), metastasis at diagnosis (yes), NLR (> median), and PLR (> median).

Conclusion

High pretreatment CAR is effectively predictive of worse survival in patients with RCC and could be a prognostic biomarker for those patients.

Predictive value of preoperative neutrophil-to-lymphocyte ratio in non-metastatic papillary renal cell carcinoma patients after receiving curative surgery

Objective

To determine the predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR) for disease-free survival (DFS) in non-metastatic papillary renal cell carcinoma (pRCC) patients following partial or radical nephrectomy.

Methods

We retrospectively analyzed 315 non-clear cell RCC patients who received curative surgery in our hospital from 2013 to 2018, from which 76 pRCC patients without metastasis (T_1-3N₀M₀) were selected. The receiver operating characteristics (ROC) curve was drawn and an NLR cut-off of 2.5 was set to achieve maximum diagnostic accuracy for predicting DFS. Kaplan-Meier method and the Cox regression model was used to determine the relationship of NLR with DFS.

Results

During a median follow-up of 28.0 months (IQR 15.9-42.1, mean 31.4), disease recurred in 12 patients (15.8%) recording a median duration of 14.4 months (IQR 8.6-22.9, mean 16.6). The 5-year DFS was 85.5% and 61.6% for the low (<2.5) and high (≥2.5) NLR groups respectively. According to Kaplan-Meier analysis, DFS was significantly lower in the high NLR group compared with that in the low NLR group (p=0.03). Univariate analysis revealed that high NLR level (HR 3.3, p=0.041), advanced pathological T stage (HR 10.1, p<0.001), larger tumor size (HR 1.2, p=0.008) and radical nephrectomy (HR 5.7, p=0.025) were associated with poor DFS, while multivariate analysis indicated that only advanced pathological T stage (HR 6.9, p=0.010) and high NLR level (HR 3.8, p=0.028) remained as the independent prognostic factors for poor DFS.

Conclusion

A high preoperative NLR level was an independent prognostic marker for DFS in the patients of non-metastatic pRCC (pT1-3N0M0) following curative surgery. This can be used as an adjuvant tool to select patients for clinical trials or more frequent follow-up strategies.