Prognostic inflammatory markers in metastatic renal cell carcinoma: Neutrophil-to-lymphocyte ratio and prognostic nutritional index

Objective: According to metastatic renal cell carcinoma treatment protocol, after the use of tyrosine kinase inhibitors (TKI) has been achieved significant improvements for the treatment of metastatic renal cell carcinoma (mRCC). In this study, we aimed to investigate the effect of neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI) on survival in patients with mRCC treated with sunitinib or pazopanib. Material and Methods: Medical data for 38 patients with mRCC were reviewed retrospectively. NLR and PNI values were dichotomized based on receiver operating characteristic (ROC) curve analysis (cut-off values: 3 and 46, respectively). Univariate and multivariate analyses were performed to identify prognostic factors for progression free survival (PFS) and overall survival (OS) using a Cox proportional hazards model. Results: Median PFS and OS were 12 and 27 months, respectively. Median PFS was 10 months in patients with NLR ≥3 while 14 months in patients with NLR <3 (p: 0.008). Median OS was 18 months in patients with NLR ≥3 while 31 months in patients with NLR <3 (p: 0.003). In patients with PNI ≥ 46, PFS was 21 months and OS was 47 months whereas in patients with PNI < 46, PFS was 8 months and OS was 13 months (p values were <0.001, <0.001 respectively). In multivariate analysis, PNI was the independent risk factor for both PFS and OS, while NLR was the independent risk factor for OS only. Conclusion: In patients with mRCC that using sunitinib or pazopanib, NLR and PNI values can be used as easily accessible prognostic markers.