ASCO GU 2018: Systemic Immune Inflammation Index and Treatment Response in Patients with Metastatic Renal Cell Cancer

San Francisco, CA ( Biomarkers to predict response are highly sought after, as they can help reduce overtreatment and help prevent delay to appropriate treatment. Inflammatory markers have been assessed in multiple malignancies. In this smaller institutional series, the authors investigate the prognostic value of the pretreatment inflammatory characteristics on treatment response and survival in patients with metastatic renal cell carcinoma (mRCC). It was a study of 149 patients, and was completed as a retrospective study.

A systemic immune inflammation index (SII) was generated and a cut off was generated using the median value (median = 844). The index was calculated as follows: neutrophil x platelet/lymphocyte. They then assessed overall survival (OS) as the primary outcome.

149 patients were assessed. Baseline characteristics: median age 60 (range 30-85); 75% male; 74% prior nephrectomy; 80% clear cell histology; 50% Fuhrman grade 3-4; 10% had sarcomatoid features.

In patients in the high SII group (SII > 844), overall survival was 10.5 months (3.59-17.5), while for patients in the low SII group (SII < 844), overall survival is 34.9 months (11.6-58.3). This does not appear to be significant as the CI cross. No p-value provided.

Interestingly, on a separate KM analysis stratifying based on ECOG status, patients with ECOG 1-2 did far better than those with ECOG 3-4. The difference was more drastic than the impact of the SII (34.6 months vs. 5.0 months).

When looking at individual components of the SII, median OS is lower in the hypercalcemic group (7 months vs.18 months, P = 0.013), in the anemia group (13 months vs. 41 months, p = 0.001) and in patients with thrombocytosis (6 months vs. 18 months p = 0.01). These were univariate analyses. * However, they don’t provide any details regarding the analysis in their poster.

In multivariate analysis, anemia, SII, and ECOG performance status were associated with worse overall survival (HR = 2.69, HR = 2.04, HR = 2.57) * However, they don’t provide any details regarding the analysis in their poster.

In patients with mRCC, SII may have a prognostic value and higher score may related with decreased overall survival. However, many of the components of the current evaluation are already evaluated and known components of the Motzer criteria for mRCC; it does not appear that this data adds much to the known literature.

Limitations / Discussion Points:
1. Flaw in the stratification – patients are categorized < 844 and > 844, but 844 itself is not included in either group. Small technical flaw.

2. Unclear why only overall survival was analyzed as the primary outcome, rather than cancer-specific survival or progression-free survival.

3. Motzer criteria for mRCC already assesses many of the components of the SII – no novel findings in the abstract.

Speaker: Kadriye Bir Yacel

Co-Authors: Arzu Yasar, Gokhan Ucar, Gungor Utkan, Nuriye Yildirim, Yuksel Urun

Institution(s): Ankara University School of Medicine, Ankara, Turkey

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA