Impact of the systemic immune-inflammation index for the prediction of prognosis and modification of the risk model in patients with metastatic renal cell carcinoma treated with first-line tyrosine kinase inhibitors

Jun Teishima; Shogo Inoue; Tetsutaro Hayashi; Koji Mita; Yasuhisa Hasegawa; Masao Kato; Mitsuru Kajiwara; Masanobu Shigeta; Satoshi Maruyama; Hiroyuki Moriyama; Seiji Fujiwara; Akio Matsubara

doi:10.5489/cuaj.6413

Impact of the systemic immune-inflammation index for the prediction of prognosis and modification of the risk model in patients with metastatic renal cell carcinoma treated with first-line tyrosine kinase inhibitors

Can Urol Assoc J. 2020 Nov;14(11):E582-E587. doi: 10.5489/cuaj.6413.

Authors

Affiliations

¹ Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
² Department of Urology, Hiroshima-City Asa Citizens Hospital, Hiroshima, Japan.
³ Department of Urology, Fukuyama Medical Center, Fukuyama, Japan.
⁴ Department of Urology, Hiroshima General Hospital, Hatsukaichi, Japan.
⁵ Department of Urology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
⁶ Department of Urology, Kure Medical Center and Chugoku Cancer Center, Kure, Japan.
⁷ Department of Urology, Miyoshi Central Hospital, Miyoshi, Japan.
⁸ Department of Urology, Onomichi General Hospital, Onomichi, Japan.
⁹ Department of Urology, Higashi-Hiroshima Medical Center, Higashi-Hiroshima, Japan.

Abstract

Introduction: International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria are the most representative risk model for patients with metastatic renal cell carcinoma (mRCC). However, the intermediate-risk group of IMDC criteria is thought to include patients with different prognoses because many of the patients are classified into the intermediate-risk group. In this study, we investigated the impact of systemic immune-inflammation index (SII), which is calculated based on neutrophil count, platelet count, and lymphocyte count, on predicting the prognosis in patients with mRCC, and its usefulness for re-classification of patients with a more sophisticated risk model.

Methods: From January 2008 to January 2018, 179 mRCC patients with a pretreatment and SII were retrospectively investigated. All patients were classified into either a high-SII group or a low-SII group based on the cutoff value of a SII at 730, as reported in previous studies; the overall survival (OS) rates in each group were compared.

Results: The median age was 65 years old. Males and females comprised 145 and 34 cases, respectively. The categories of favorable-, intermediate-, and poor-risk groups in the IMDC model were assessed in 39, 102, and 38 cases, respectively. The median observation period was 24 months. The low-SII and high-SII groups consisted of 73 and 106 cases, respectively. The 50% OS in the high-SII group was 21.4 months, which was significantly worse than that in the low-SII group (49.7 months; p<0.0001). Multivariate analysis showed that a high SII was an independent predictive factor for a worse OS. Next, we constructed a modified IMDC risk model that included the SII instead of a neutrophil count and a platelet count. By using this modified IMDC model, all cases were re-classified into four groups of 33, 52, 81, and 13 cases with 50% OS of 88.8, 45.9, 29.4, and 4.8 months, respectively.

Conclusions: The SII is useful for establishing a more sophisticated prognostic model that can stratify mRCC patients into four groups with different prognoses.