ORLANDO, FL USA (UroToday.com) - Over the last several years, prognostic systemic inflammatory markers such as, erythrocyte sedimentation rate (ESR), platelet count, C-reactive protein (CRP), vascular endothelial growth factors (VEGF), and serum interleukin-6 levels (IL-6), related to RCC outcomes have been described.
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More recently, there has been an increased interest in evaluating the host’s inflammatory and immune response to tumors. One routinely obtained and readily available maker of the systemic inflammatory response is the absolute lymphocyte count (ALC), and its preoperative prognostic value as an independent predictor of disease free survival (DFS) and all-cause overall survival (OS) in clear RCC has been previously described by our group here at Fox Chase Cancer Center and published in Journal of Urology.
Papillary RCC (PRCC) is the second most common histologic subtype of RCC which originates from a different biological pathway, and along with clear cell histology, it makes up the majority of RCC cases seen in clinical settings. The aim this study was to evaluate the prognostic significance of preoperative ALC in PRCC series. It was hypothesized that preoperative ALC may be a significant predictor of PRCC outcome as well. And since ccRCC and PRCC constitute the vast majority of RCCs, then ALC can be used as a useful preoperative predictor of RCC outcome even if the histology is not known yet.
The prospectively maintained renal cancer database at FCCC, and patients with preoperative ALC, within 3 months prior to surgery, were eligible for the study. Since the outcome could have been affected by another primary rather than the PRCC index tumor, those patients who had more than one surgery for management of multifocal or bilateral renal tumors were excluded. ALC was examined as a continuous and dichotomous variable. Correlations between ALC and age, gender, smoking, Charlson comorbidity index (CCI), pathologic (pT) stage, PRCC subtype, and TNM stage were evaluated. Differences in overall survival (OS) & cancer-specific survival (CSS) by ALC status were assessed and then Cox proportional hazards modeling was used to conduct multivariable analyses.
A total of 192 patients met the inclusion criteria. As a continuous variable, preoperative ALC was associated with higher TNM stage (p=0.001) and older age (p=0.01). As a dichotomous variable, lymphopenia ( < 1 300 cells/µl) was associated with higher TNM stage (p=0.003). On MVA, controlling for covariates, after a median follow up of 37.3 months, lymphopenia was associated with inferior OS (HR=2.3 [95%CI 1.2−4.3], p=0.011) and trended to significance for CSS (p=0.071). Among non-metastatic, lymphopenic patients, OS at 37.5 months was shorter compared to those with normal ALC (83% vs 93%, p=0.0006). Authors were able to show that similar to clear renal cell carcinoma, in patients with PRCC, lymphopenia is associated with lower survival independent of TNM stage, age, and histology. ALC may provide an additional pre-operative prognostic factor.
Click HERE to view the poster from this session
Click HERE to listen to Reza Mehrazin, MD, one of the authors of this study
Presented by Reza Mehrazin, MD at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
Fox Chase Cancer Center, Philadelphia, PA USA
Written by Reza Mehrazin, MD, medical writer for UroToday.com