Introduction

Our present study aimed to investigate the impact of kinetics of biomarkers on the prediction of overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) treated with a tyrosine kinase inhibitor (TKI).

Methods

Biomarkers including C-reactive protein (CRP), neutrophil count (Neu), neutrophil-lymphocyte ratio (NLR), platelet count (Plt), hemoglobin (Hb), serum lactate dehydrogenase (LDH), and serum albumin (Alb) in 118 cases of molecular targeted therapy for mRCC were measured before the first-line targeted agents started to be prescribed and at the first CT scan during treatment. All cases were classified into higher and lower biomarker groups in accordance with their data when treatments started. All groups were further classified into two subgroups on the basis of the kinetics of all biomarkers after first-line targeted therapy: decreased and non-decreased biomarker subgroups for the higher biomarker groups, or increased and non-increased biomarker subgroups for the lower biomarker groups. All cases were also classified in accordance with their other clinical backgrounds, and the overall survival (OS) of each subgroup was analyzed.

Results

The patients had a median age of 65 years old; and 102 and 16 were diagnosed as having a clear and non-clear cell histology, respectively. In the first-line therapy, 74, 42, and 2 cases were treated with sunitinib, sorafenib, and pazopanib, respectively. The median observation period was 23.4 months. Cases with CRP higher than 0,5mg/dl, Neu higher than the upper limit of normal (ULN), NLR higher than 2.5, Plt higher than ULN, anemia, and hypoalbuminemia had significantly worse OS than other cases (p<0.0001, p=0.0008, p<0.0001, p<0.0001, p=0.0094, and p<0.0001, respectively). Multivariate analysis revealed that pretreated CRP (hazard ratio (HR): 2.093, p=0.0179) and NLR (HR: 2.099, p=0.0431) were independent predictive factors of OS. In the higher CRP group and higher Neu group, the decreased CRP subgroup (1 year, 85.0%) and the decreased Neu subgroup (1 year, 73.9%) had significantly better OS than the non-decreased CRP subgroup (1-year, 37.2%, p<0.0001) and non-decreased Neu subgroup (1-year, 45.5%, p=0.0445). Multivariate analyses in the higher CRP group revealed that decrease of CRP was an independent predictive factor for OS (HR: 0.176, p=0.0008).

Conclusions

Decrease of CRP and pretreatment CRP can be novel predictive factors for OS in mRCC patients treated with molecular targeted therapy.

Funding

none