Prognostic model including the combination of platelet count and neutrophil–lymphocyte ratio for metastatic renal cell carcinoma treated with sunitinib

Abstract BackgroundThe association between the combination of platelet count and neutrophil–lymphocyte ratio (COP-NLR) at the time of adverse events during sunitinib treatment and prognosis is unclear, and prognostic models combining the prognostic factors of sunitinib have not been well studied. To develop a prognostic model that includes the COP-NLR to predict the prognosis of patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib.MethodsWe performed a retrospective cohort study of 102 patients treated with sunitinib for mRCC between 2008 and 2020 in three hospitals associated with Showa University, Japan. The primary outcome was overall survival (OS). The collected data included baseline patient characteristics, adverse events, laboratory values, and COP-NLR scores within the first 6 weeks of sunitinib treatment. Prognostic factors of OS were analyzed using the Cox proportional hazards model. The integer score was derived from the hazard ratio (HR) of these factors and was divided into three groups. The survival curves were visualized using the Kaplan–Meier method and estimated using a log-rank test.ResultsThe median OS was 32.3 months. Multivariate analysis showed that the number of metastatic sites, Memorial Sloan Kettering Cancer Center risk group, number of metastases, hypertension, modified Glasgow Prognostic Score, and 6-week COP-NLR were significantly associated with OS. A higher 6-week COP-NLR was significantly associated with a shorter OS (p < 0.001). The HRs of the five factors for OS were scored (hypertension, mGPS, and 6-week COP-NLR=1 point; number of metastatic sites=2 points; MSKCC risk group=3 points) and patients divided into three groups (≤1, 2–3, and ≥4). The low-risk (≤1) group had significantly longer OS than the high-risk (≥4) group (median OS: 99.0 vs 6.2 months, p < 0.001).ConclusionsThe 6-week COP-NLR, which was associated with OS, was an important prognostic factor in patients with mRCC treated with sunitinib. The developed prognostic model for OS, including the 6-week COP-NLR, will be useful in decision-making to continue sunitinib in the early treatment stage of patients with mRCC.