Inflammatory indices and clinical factors in metastatic renal cell carcinoma patients treated with nivolumab: the development of a novel prognostic score (Meet-URO 15 study)

Sara Elena Rebuzzi, Alessio Signori, Giuseppe Luigi Banna, Marco Maruzzo, Ugo De Giorgi, Paolo Pedrazzoli, Andrea Sbrana, Paolo Andrea Zucali, Cristina Masini, Emanuele Naglieri, Giuseppe Procopio, Sara Merler, Laura Tomasello, Lucia Fratino, Cinzia Baldessari, Riccardo Ricotta, Stefano Panni, Veronica Mollica, Maria Sorarù, Matteo SantoniAlessio Cortellini, Veronica Prati, Hector Josè Soto Parra, Marco Stellato, Francesco Atzori, Sandro Pignata, Carlo Messina, Marco Messina, Franco Morelli, Giuseppe Prati, Franco Nolè, Francesca Vignani, Alessia Cavo, Giandomenico Roviello, Francesco Pierantoni, Chiara Casadei, Melissa Bersanelli, Silvia Chiellino, Federico Paolieri, Matteo Perrino, Matteo Brunelli, Roberto Iacovelli, Camillo Porta, Sebastiano Buti, Giuseppe Fornarini

Research output: Contribution to journalArticlepeer-review

Abstract

Background:Despite the survival advantage, not all metastatic renal cell carcinoma (mRCC) patients achieve a long-term benefit from immunotherapy. Moreover, the identification of prognostic biomarkers is still an unmet clinical need.Methods:This multicenter retrospective study investigated the prognostic role of peripheral-blood inflammatory indices and clinical factors to develop a novel prognostic score in mRCC patients receiving at least second-line nivolumab. The complete blood count before the first cycle of therapy was assessed by calculating neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), and systemic inflammation response index (SIRI). Clinical factors included pre-treatment International Metastatic RCC Database Consortium (IMDC) score, line of therapy, and metastatic sites.Results:From October 2015 to November 2019, 571 mRCC patients received nivolumab as second- and further-line treatment in 69% and 31% of cases. In univariable and multivariable analyses all inflammatory indices, IMDC score, and bone metastases significantly correlated with overall survival (OS). The multivariable model with NLR, IMDC score, and bone metastases had the highest c-index (0.697) and was chosen for the developing of the score (Schneeweiss scoring system). After internal validation (bootstrap re-sampling), the final index (Meet-URO score) composed by NLR, IMDC score, and bone metastases had a c-index of 0.691. It identified five categories with distinctive OSs: group 1 (median OS ? mOS?=?not reached), group 2 (mOS?=?43.9?months), group 3 (mOS?=?22.4?months), group 4 (mOS?=?10.3?months), and group 5 (mOS?=?3.2?months). Moreover, the Meet-URO score allowed for a fine risk-stratification across all three IMDC groups.Conclusion:The Meet-URO score allowed for the accurate stratification of pretreated mRCC patients receiving nivolumab and is easily applicable for clinical practice at no additional cost. Future steps include its external validation, the assessment of its predictivity, and its application to first-line combinations.
Original languageEnglish
Pages (from-to)17588359211019642
JournalTherapeutic Advances in Medical Oncology
Volume13
DOIs
Publication statusPublished - 2021

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