Inflammation indexes and body mass index (BMI) are easily evaluated, predict survival and are potentially modifiable. We evaluated the potential association of inflammatory indexes and BMI with the clinical outcome of patients with renal cell carcinoma (RCC) undergoing immune checkpoint inhibitor therapy.
A prospective cohort of patients with metastatic RCC treated with nivolumab enrolled in the Italian Expanded Access Program (EAP) from July 2015 through April 2016 was examined. Reference measures of inflammation were identified for neutrophil to lymphocyte ratio (NLR) 2) versus normal BMI (<25 kg/m2).
Among 313 evaluable patients, 235 (75.1%) were male, median age was 65 years (range, 40 to 84), with 105 (33.69%) ≥70 years. In univariate analysis, age, performance status, BMI, SII, NLR and PLR were able to predict outcome. In multivariate analyses, SII ≥1375, BMI <25 and age ≥70 years independently predicted OS (HR, 2.96; 95% CI, 2.05-4.27; HR, 1.59; 95% CI, 1.10-2.30 and HR, 1.65; 95% CI, 1.07-2.55, respectively). A patient with both SII ≥1375 and BMI <25 was estimated to have much worse OS (HR, 3.37; 95% CI, 2.29-4.95, P <0.0001) than a patient with neither or only one risk factor. SII changes at 3 months predicted OS (P <0.0001).
Normal BMI combined with inflammation tripled the risk of death, suggesting that these biomarkers are critical prognostic factors for OS in patients with RCC treated with nivolumab.
Clinical cancer research : an official journal of the American Association for Cancer Research. 2019 Apr 09 [Epub ahead of print]
Ugo De Giorgi, Giuseppe Procopio, Diana Giannarelli, Roberto Sabbatini, Alessandra Bearz, Sebastiano Buti, Umberto Basso, Manfred Mitterer, Cinzia Ortega, Paolo Bidoli, Francesco Ferraù, Lucio Crinò, Antonio Frassoldati, Paolo Marchetti, Enrico Mini, Alessandro Scoppola, Claudio Verusio, Giuseppe Fornarini, Giacomo Cartenì, Claudia Caserta, Cora Sternberg
Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) - IRCCS ., Medical Oncology, fondazione IRCCS Istituto nazionale Tumori., Department of Experimental Clinical Oncology, Istituto Nazionale Tumori Regina Elena., Oncology and Hematology, AOU di Modena, Modena., Medical Oncology, CRO-IRCSS., Medicali Oncology Unit, University Hospital of Parma., Istituto Oncologico Veneto, Istituto Oncologico Veneto., Ospedale "Franz Tappeiner", Merano., Ospedale S. Lazzaro ASL CN2 Alba-Bra., Medical Oncology Unit, ASST-Monza San Gerardo Hospital., Ospedale "S. Vincenzo", Taormina., 6. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola., Arcispedale S. Anna", Ferrara., Oncology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome., Health Sciences, Università degli Studi di Firenze., Oncology, Istituto Dermopatico dell'Immacolata, Roma., Oncology, P.O. di Saronno, Varese., Ospedale "S. Martino", Genova., AO "A. Cardarelli", Napoli., AOU Santa Maria, Terni., San Camillo and Forlanini Hospitals.