Prognostic significance of host immune status in patients with late relapsing renal cell carcinoma treated with targeted therapy

Target Oncol. 2015 Dec;10(4):517-22. doi: 10.1007/s11523-014-0356-3. Epub 2015 Jan 6.


We aimed to assess the prognostic role of pretreatment neutrophilia, lymphocytopenia, and neutrophil to lymphocyte ratio (NLR) in patients treated with vascular endothelial growth factor-tyrosine kinase inhibitors (VEGFR-TKIs) for late relapsing (>5 years) metastatic renal cell carcinoma (mRCC). Data were collected from 13 Italian centers involved in the treatment of metastatic RCC. Late relapse was defined as >5 years after initial radical nephrectomy. One hundred fifty-one patients were included in this analysis. Among them, MSKCC risk score was favorable in 68 %, intermediate in 29 %, and poor in 3 %. Fifty-six patients (37 %) had NLR ≥3 at the start of VEGFR-TKI therapy (group A), while 95 had lower NLR (63 %, group B). The median overall survival (OS) was 28.8 months in group A and 68.7 months (95 % confidence interval (CI) 45.3-NA) in group B (p < 0.001). The median progression-free survival (PFS) was 15.8 months in group A and 25.1 months in group B (p = 0.03). At multivariate analysis, MSKCC risk group and NLR were independent prognostic factors for both OS and PFS. Pretreatment NLR is an independent prognostic factor for patients with late relapsing mRCC treated with first-line VEGFR-TKIs. A better characterization of baseline immunological impairment may optimize the management of this RCC subpopulation.

Keywords: Late recurrence; Neutrophil to lymphocyte ratio; Prognosis; Renal cell carcinoma; Tyrosine kinase inhibitors.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Renal Cell / blood
  • Carcinoma, Renal Cell / drug therapy*
  • Carcinoma, Renal Cell / immunology*
  • Carcinoma, Renal Cell / pathology
  • Female
  • Humans
  • Kidney Neoplasms / immunology*
  • Kidney Neoplasms / pathology
  • Kidney Neoplasms / therapy
  • Leukocyte Disorders / immunology
  • Leukocyte Disorders / pathology
  • Lymphopenia / immunology
  • Lymphopenia / pathology
  • Male
  • Middle Aged
  • Molecular Targeted Therapy
  • Neoplasm Recurrence, Local / immunology
  • Neoplasm Recurrence, Local / pathology
  • Prognosis
  • Protein Kinase Inhibitors / therapeutic use*
  • Receptors, Vascular Endothelial Growth Factor / antagonists & inhibitors
  • Retrospective Studies
  • Treatment Outcome


  • Protein Kinase Inhibitors
  • Receptors, Vascular Endothelial Growth Factor