External validation of the systemic immune-inflammation index as a prognostic factor in metastatic renal cell carcinoma and its implementation within the international metastatic renal cell carcinoma database consortium model
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We conducted a study to validate the influence of the systemic immune-inflammation index (SII) on overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) and to verify whether the implementation of the SII in place of neutrophil and platelet counts within the International Metastatic Renal Cell Carcinoma Consortium (IMDC) model might increase its prognostic accuracy.
Patients and methods
We retrospectively analyzed consecutive patients with mRCC, who were treated with first-line tyrosine kinase inhibitors from 2008 to 2016 in two major oncology centres in Poland. We stratified patients into low SII (< 730) and high SII (≥ 730) groups according to a recent literature report. We used multivariable Cox proportional hazards regressions (CPHRs) to assess the impact of the SII on OS and concordance, global ‘goodness-of-fit’, calibration and reclassification measures to quantify a potential prognostic benefit from the modification of the IMDC model.
Overall, 502 patients (294 with low and 208 with high SII) were included. Median OS was 36.7 months [95% confidence interval (CI) 30.4–41.5 months] and 17.0 months (95% CI 12.5–19.6 months) in the low and high SII groups, respectively. The SII status was significant in CPHRs with the hazard ratio ranging from 1.38 to 1.68. All prognostic accuracy measures favored the SII-modified-IMDC model over the original IMDC model.
Using an external dataset, we showed that high SII was an independent factor for poor OS. The addition of the SII to the IMDC model in place of neutrophil and platelet counts increased the model’s prognostic performance.
KeywordsInternational metastatic renal cell carcinoma database consortium model Overall survival Prognostic factor Systemic immune-inflammation index Tyrosine kinase inhibitors
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The local ethics committee approved the study (Agreement no. 1/WIM/2014).
The individual informed consent was not required due to retrospective nature of the study.
- 6.Ko JJ, Xie W, Kroeger N et al (2015) The International Metastatic Renal Cell Carcinoma Database Consortium model as a prognostic tool in patients with metastatic renal cell carcinoma previously treated with first-line targeted therapy: a population-based study. Lancet Oncol 16:293–300CrossRefGoogle Scholar
- 7.Tanaka N, Mizuno R, Yasumizu Y et al (2017) Prognostic value of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma treated with first-line and subsequent second-line targeted therapy: a proposal of the modified-IMDC risk model. Urol Oncol 35:39.e19–39.e28CrossRefGoogle Scholar
- 8.Chrom P, Stec R, Bodnar L et al (2018) Incorporating neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in place of neutrophil count and platelet count improves prognostic accuracy of the International Metastatic Renal Cell Carcinoma Database Consortium model. Cancer Res Treat 50:103–110CrossRefGoogle Scholar
- 21.Song W, Yeh CR, He D et al (2015) Infiltrating neutrophils promote renal cell carcinoma progression via VEGFa/HIF2α and estrogen receptor β signals. Oncotarget 6:19290–19304Google Scholar