Systemic immune-inflammation index predicts the clinical outcome in patients with metastatic renal cell cancer treated with sunitinib
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Cristian Lolli1, Umberto Basso2, Lisa Derosa3, Emanuela Scarpi1, Teodoro Sava4, Matteo Santoni5, Simon J. Crabb6, Francesco Massari4,8, Michele Aieta7, Vincenza Conteduca1, Marco Maruzzo2, Francesca La Russa4, Matthew Wheater6, Rossana Berardi5, Luca Galli3, Ugo De Giorgi1
1Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
2Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
3Oncology Unit 2, University Hospital of Pisa, Pisa, Italy
4Department of Medical Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
5Department of Medical Oncology, Polytechnic University of the Marche Region, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I-GM Lancisi and G Salesi, Ancona, Italy
6Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
7Department of Medical Oncology, IRCCS CROB Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
8Present address: Division of Oncology, S.Orsola-Malpighi Hospital, Bologna, Italy
Ugo De Giorgi, email: [email protected]
Keywords: systemic immune inflammation index, renal cell carcinoma, RCC, prognostic factor, sunitinib
Received: April 20, 2016 Accepted: May 23, 2016 Published: July 09, 2016
Background: In this retrospective analysis, we explored the prognostic and predictive value of the systemic immune-inflammation index (SII), based on lymphocyte, neutrophil, and platelet counts, at baseline and changes at week 6 during first-line sunitinib in patients with metastatic renal cell cancer (RCC).
Results: Patients were stratified into high SII (≥ 730) and low SII (< 730) groups. SII was associated with objective response, p < 0.0001. The median PFS was 6.3 months (95% CI 5.5–8.9) in patients with SII ≥ 730 and 18.7 months (95% CI 14.7–22.8) in those with SII < 730, p < 0.0001. The median OS was 43.6 months (95% CI 35.3–52.1) in patients with SII < 730, and 13.5 months (95% CI 9.8–18.5) in those with SII ≥ 730, p < 0.0001. In multivariate analysis, performance status, IMDC score and SII were able to predict OS (HR = 3.29, HR = 1.71 and HR = 1.79, respectively).
Materials and Methods: We included 335 consecutive RCC patients treated with first-line sunitinib. The X-tile 3.6.1 software (Yale University, New Haven, CT) was used for bioinformatic analysis of the data to determine the cutoff value of SII. Progression-free survival (PFS), overall survival (OS) and their 95% confidence interval (95% CI) were estimated by Kaplan-Meier method and compared with logrank test. The impact of SII conversion at week 6 of treatment on PFS and OS was evaluated by Cox regression analyses.
Conclusions: The SII and its changes during treatment represent a powerful prognostic indicator of clinical outcome in patients with metastatic RCC.
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