SAN FRANCISCO, CA USA (UroToday.com) - Even though observation remains standard of care after partial or radical nephrectomy, those patients who are considered high risk and eligible should be considered for clinical trials for possible neoadjuvant or adjuvant treatments.
Existing preoperative RCC models that risk-stratify patients are useful guides after surgery but are of limited value in a preoperative setting. Although there are nomograms that can assist clinicians in risk stratifying RCC patients, they are of limited value in the preoperative setting. More recently, there has been an increased interest in evaluating the host’s role of inflammatory response to tumors. It has been shown that the systemic inflammatory response causes change in the relative levels of circulating white blood cells, resulting in a decrease in absolute lymphocyte count (ALC) with the progression of RCC. To date, no prior studies have looked at the role of preoperative ALC as a potential preoperative prognostic factor in papillary RCC (PRCC) patients. PRCCs are known to develop from a different biological pathway and behave differently than other renal cell carcinomas. We presented an analysis of a large, uniform, single institution series of patients with PRCC, and examined the relationship of preoperative ALC to tumor grade, stage, smoking history, medical comorbidities and overall survival (OS).
We retrospectively analyzed our prospectively maintained renal cancer database at Fox Chase Cancer Center and identified patients with pathologic diagnosis of papillary RCC after partial or radical nephrectomy. Patients with preoperative ALC value within 3 months prior to surgery were eligible for the study. ALC of 1 300 cells/µl was used as the cutoff value (our lowest laboratory reference value). We evaluated the correlation between ALC and age, gender, Charlson comorbidity index (CCI), pathologic T stage, nuclear grade or PRCC subtype, and overall TNM stage. Differences in OS by ALC status were assessed using the log−rank test. Cox proportional hazards modeling was used for multivariable analyses. One hundred ninety-two patients met the inclusion criteria with a median follow-up of 37.3 months. As a continuous variable, ALC was associated with higher pT stage (p=0.001), TNM stage (p=0.001), and older age (p=0.01). ALC below 1,300 cells/µl was also associated with pT (p < 0.001) and overall stage (p=0.003). On MVA, ALC < 1.3 was associated with inferior OS (HR=2.3 [95%CI 1.2−4.5], p=0.011), independent of T, N, and M stages, PRCC subtype, and age. At 36-months, OS in nonmetastatic patients who had lymphopenia prior to surgery was approximately 10% lower than those patients with ALC > 1.3, preoperatively. We able to conclude that in patients with PRCC, lymphopenia is associated with lower OS independent of T stage, N stage, M stage, age, and PRCC type. ALC may provide an additional pre-operative prognostic factor and can be helpful in patient counseling and design of clinical trials.
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Highlights of a presentation by Reza Mehrazin, MD at the 2014 Genitourinary Cancers Symposium - January 30 - February 1, 2014 - San Francisco Marriott Marquis - San Francisco, California USA