Association of systemic inflammation index and body mass index with survival in patients with renal cell cancer treated with nivolumab

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 & 1 others Cora N. Sternberg

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Abstract

Purpose: 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. Experimental Design: A prospective cohort of patients with metastatic RCC treated with nivolumab enrolled in the Italian Expanded Access Program from July 2015 through April 2016 was examined. Reference measures of inflammation were identified for neutrophil-to-lymphocyte ratio (NLR) </≥ 3, systemic immune inflammation index (SII) </ ≥ 1,375, and platelet-tolymphocyte ratio (PLR) </ ≥ 232. Patients were classified as high BMI (≥25 kg/m2) versus normal BMI (<25 kg/m2). Results: Among 313 evaluable patients, 235 (75.1%) were male, and median age was 65 years (range, 40-84 years), 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 ≥1,375, BMI <25 kg/m2, and age ≥70 years independently predicted overall survival [OS; HR = 2.96, 95% confidence interval (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 ≥1,375 and BMI <25 kg/m2 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). Conclusions: 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.

Original languageEnglish
Pages (from-to)3839-3846
Number of pages8
JournalClinical Cancer Research
Volume25
Issue number13
DOIs
Publication statusPublished - Jan 1 2019

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Renal Cell Carcinoma
Body Mass Index
Inflammation
Survival
Confidence Intervals
Neutrophils
Blood Platelets
Lymphocytes
nivolumab
Research Design
Multivariate Analysis
Biomarkers

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Association of systemic inflammation index and body mass index with survival in patients with renal cell cancer treated with nivolumab. / De Giorgi, Ugo; Procopio, Giuseppe; Giannarelli, DIana; Sabbatini, Roberto; Bearz, Alessandra; Buti, Sebastiano; Basso, Umberto; Mitterer, Manfred; Ortega, Cinzia; Bidoli, Paolo; Ferraù, Francesco; Crinò, Lucio; Frassoldati, Antonio; Marchetti, Paolo; Mini, Enrico; Scoppola, Alessandro; Verusio, Claudio; Fornarini, Giuseppe; Cartenì, Giacomo; Caserta, Claudia; Sternberg, Cora N.

In: Clinical Cancer Research, Vol. 25, No. 13, 01.01.2019, p. 3839-3846.

Research output: Contribution to journalArticle

De Giorgi, U, Procopio, G, Giannarelli, DI, Sabbatini, R, Bearz, A, Buti, S, Basso, U, Mitterer, M, Ortega, C, Bidoli, P, Ferraù, F, Crinò, L, Frassoldati, A, Marchetti, P, Mini, E, Scoppola, A, Verusio, C, Fornarini, G, Cartenì, G, Caserta, C & Sternberg, CN 2019, 'Association of systemic inflammation index and body mass index with survival in patients with renal cell cancer treated with nivolumab', Clinical Cancer Research, vol. 25, no. 13, pp. 3839-3846. https://doi.org/10.1158/1078-0432.CCR-18-3661
De Giorgi, Ugo ; Procopio, Giuseppe ; Giannarelli, DIana ; Sabbatini, Roberto ; Bearz, Alessandra ; Buti, Sebastiano ; Basso, Umberto ; Mitterer, Manfred ; Ortega, Cinzia ; Bidoli, Paolo ; Ferraù, Francesco ; Crinò, Lucio ; Frassoldati, Antonio ; Marchetti, Paolo ; Mini, Enrico ; Scoppola, Alessandro ; Verusio, Claudio ; Fornarini, Giuseppe ; Cartenì, Giacomo ; Caserta, Claudia ; Sternberg, Cora N. / Association of systemic inflammation index and body mass index with survival in patients with renal cell cancer treated with nivolumab. In: Clinical Cancer Research. 2019 ; Vol. 25, No. 13. pp. 3839-3846.
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abstract = "Purpose: 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. Experimental Design: A prospective cohort of patients with metastatic RCC treated with nivolumab enrolled in the Italian Expanded Access Program 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). Results: Among 313 evaluable patients, 235 (75.1{\%}) were male, and median age was 65 years (range, 40-84 years), 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 ≥1,375, BMI <25 kg/m2, and age ≥70 years independently predicted overall survival [OS; HR = 2.96, 95{\%} confidence interval (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 ≥1,375 and BMI <25 kg/m2 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). Conclusions: 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.",
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T1 - Association of systemic inflammation index and body mass index with survival in patients with renal cell cancer treated with nivolumab

AU - De Giorgi, Ugo

AU - Procopio, Giuseppe

AU - Giannarelli, DIana

AU - Sabbatini, Roberto

AU - Bearz, Alessandra

AU - Buti, Sebastiano

AU - Basso, Umberto

AU - Mitterer, Manfred

AU - Ortega, Cinzia

AU - Bidoli, Paolo

AU - Ferraù, Francesco

AU - Crinò, Lucio

AU - Frassoldati, Antonio

AU - Marchetti, Paolo

AU - Mini, Enrico

AU - Scoppola, Alessandro

AU - Verusio, Claudio

AU - Fornarini, Giuseppe

AU - Cartenì, Giacomo

AU - Caserta, Claudia

AU - Sternberg, Cora N.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: 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. Experimental Design: A prospective cohort of patients with metastatic RCC treated with nivolumab enrolled in the Italian Expanded Access Program 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). Results: Among 313 evaluable patients, 235 (75.1%) were male, and median age was 65 years (range, 40-84 years), 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 ≥1,375, BMI <25 kg/m2, and age ≥70 years independently predicted overall survival [OS; HR = 2.96, 95% confidence interval (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 ≥1,375 and BMI <25 kg/m2 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). Conclusions: 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.

AB - Purpose: 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. Experimental Design: A prospective cohort of patients with metastatic RCC treated with nivolumab enrolled in the Italian Expanded Access Program 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). Results: Among 313 evaluable patients, 235 (75.1%) were male, and median age was 65 years (range, 40-84 years), 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 ≥1,375, BMI <25 kg/m2, and age ≥70 years independently predicted overall survival [OS; HR = 2.96, 95% confidence interval (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 ≥1,375 and BMI <25 kg/m2 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). Conclusions: 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.

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