818P - Prognostic role of pre-treatment neutrophil to lymphocyte ratio (NLR) in patients with metastatic renal cell carcinoma (mRCC) on sunitinib therapy

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anticancer Agents
Renal Cell Cancer
Translational Research
Basic Principles in the Management and Treatment (of cancer)
Biological Therapy
Presenter Karla Souza
Citation Annals of Oncology (2014) 25 (suppl_4): iv280-iv304. 10.1093/annonc/mdu337
Authors K.T. Souza1, R. Barroso-Sousa2, L.G. Fonseca3, C. Dzik2
  • 1Oncology, Instituto do Cancer do Estado de Sao Paulo, 01246000 - sao paulo/BR
  • 2Medical Oncology, ICESP, 01246000 - Sao Paulo/BR
  • 3Oncology, ICESP, 01246000 - Sao Paulo/BR



Background: The NLR is an index of systemic inflammation and seems to be associated with outcome in several cancer types, including mRCC. The primary aim of our study was to evaluate the prognostic role of pre-treatment NLR on overall survival (OS) of patients with mRCC receiving sunitinib.


We retrospectively studied charts of a cohort of patients with mRCC who started sunitinib between 2009 and 2013 at our institution and presented the following inclusion criteria: 1) Karnofsky performance status (KPS) of 60 or more at baseline assessment; 2) available data on pre-treatment NLR. Exclusion criteria included recent (< 1month) treatment with steroids or other systemic antineoplastic therapy or recent onset of infection (<1 month) known to be associated with a change of blood counts. Data were collected from each individual patient file on known prognostic factors for mRCC. Kaplan-Meier and log-rank analyses were employed on analysis of OS. ROC curve analysis was made to define the best NLR cut-off value. Multivariate analysis using Cox regression model was performed to determine prognostic role of pre-treatment NLR on these clinical outcomes after adjusting for confounding covariates.


A total of 90 eligible patients were identified and included in this analysis. Median age was 58.9 years (19.6-85.9). Most patients were male (65.6%), had clear cell histology (73.3%) and had undergone to prior nephrectomy (72.2%). NLR values were: Mean 3.99, Median 3.00, 95%CI 1.02 – 11.53. The best NLR cut-off value was found to be ≤3.80 versus > 3.80. Sixty of 90 (33%) had an elevated NLR (>3.80) at baseline. Patients with pre-treatment elevated NLR had a higher prevalence of poor Motzer risk (53.3% vs 26.7% vs; p = 0.05). Median OS was significantly lower in high NLR group 8.1 vs 13.1 months (p = 0.006). Multivariate analysis revealed that in a model adjusted for age, gender, prior nephrectomy and Motzer's prognostic score, a high pre-treatment NLR was found to be an independent variable associated with poor OS (odds ratio = 2.58; 95% CI = 1.36 – 4.89; p = 0.003).


This data corroborates with previous studies in mRCC patients suggesting that pre-treatment NLR is independently associated with OS in this population. Further prospective studies should be evaluating this feature in mRCC population.


All authors have declared no conflicts of interest.