Post-treatment neutrophil-to-lymphocyte ratio in predicting prognosis in patients with metastatic clear cell renal cell carcinoma receiving sunitinib as first line therapy

Purpose: Neutrophil-to-lymphocyte ratio (NLR) was evaluated as a prognostic factor in patients with metastatic clear cell renal cell carcinoma (RCC) receiving sunitinib as first line therapy. Methods: Between December 2005 and December 2011, 109 patients with metastatic clear cell RCC were treated with sunitinib. The values of NLR were assessed at two time points: at baseline (pre-treatment) and on day 1 of the second cycle (post-treatment). The prognostic significance of NLR on treatment outcome was evaluated with adjustment for known confounding risk factors. Results: The median follow-up duration after sunitinib treatment was 24 months. There was no association between the pre-treatment NLR and tumor response (median pre-treatment NLRs: 2.2 for partial response [PR], 2.3 for stable disease [SD], and 1.9 for progressive disease [PD]; p = 0.531). However, lower post-treatment NLR (1.1 for PR, 1.2 for SD, 2.3 for PD; p = 0.021) and larger reduction in NLR after treatment (-45.8% for PR, -45.6% for SD, 14.8% for PD; p = 0.009) was significantly associated with a better tumor response. When the patients were divided into two subgroups according to the cutoff value of the post-treatment NLR 1.1, the differences in median cancer-specific survival were observed between subgroups (not reached vs. 19.0 months, p = 0.012). In multivariate analysis, body mass index, MSKCC risk group, serum hemoglobin, and post-treatment NLR were significantly associated with cancer-specific mortality. Conclusions: Higher post-treatment NLR was associated with poor prognosis. An early reduction in the NLR after sunitinib treatment may indicate survival benefit in patients with metastatic clear cell RCC.