scholarly journals The prognostic significance of NLR in non-metastatic renal cell carcinoma undergoing nephrectomy, A meta-analysis

2019 ◽  
Author(s):  
Li Na ◽  
Huimin Feng ◽  
Ligang Wu ◽  
Xuebo Han ◽  
Jia Cao ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Cochrane Library ◽  
Term Survival ◽  
Metastatic Rcc

Abstract INTRODUCTION Neutrophil to Lymphocyte ratio (NLR) has been reported to correlate with poor survivals in many tumors. However, the association between preoperative NLR elevation and survival outcome in non-metastatic renal cell carcinoma (RCC) underdoing nephrectomy remains controversial. The aim of this meta-analysis was to investigate the prognostic significance of elevated NLR in non-metastatic RCC. EVIDENCE ACUISITION We systematically searched PubMed, EmBase, and the Cochrane Library databases in may 2018. Cancer specific survival (CSS), disease-free survival (DFS) and overall survival (OS) were pooled by hazard ratio (HR) with corresponding 95% confidence interval. EVIDENCE SYNTHESIS A total of 3,175 patients from 8 studies were analyzed. The results demonstrated that elevated pretreatment NLR was significantly related to poor CSS (HR 1.91, 95% CI=1.53-2.40), DFS (HR 1.38, 95% CI=1.09-1.74), and OS (HR 1.84, 95% CI=1.58-2.14) in patients with non-metastatic RCC. CONCLUSION Elevated NLR indicates a poor long-term survival (CSS, DFS and OS) in non-metastatic RCC. Patients with elevated NLR are more likely to have poor prognosis than those with lower NLR.

scholarly journals Prognostic Value of Pretreatment Prognostic Nutritional Index in Patients With Renal Cell Carcinoma: A Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Changqing Mao ◽  
Weixin Xu ◽  
Weina Ma ◽  
Chun Wang ◽  
Zhaojiao Guo ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Prognostic Nutritional Index ◽  
Cochrane Library ◽  
Free Survival ◽  
Nutritional Index

BackgroundThe pretreatment prognostic nutritional index (PNI) is correlated with poor prognosis in several malignancies. However, the prognostic role of PNI in patients with renal cell carcinoma (RCC) remains unclear. Therefore, we performed a meta-analysis to investigate the prognostic significance of PNI in patients with RCC.MethodsWe searched the PubMed, Web of Science, Embase, Scopus, and Cochrane Library databases up to February 2021. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were used to estimate correlation between PNI and survival endpoints in RCC.ResultsTen studies with 4,908 patients were included in the meta-analysis. The pooled results indicated that a low PNI associated with poor overall survival (HR = 2.10, 95% CI = 1.67–2.64, p<0.001), shorter progression-free survival, disease-free survival, recurrence-free survival (HR = 1.99, 95% CI = 1.67–2.36, p<0.001), and poor cancer-specific survival (HR = 2.95, 95% CI = 1.61–5.39, p<0.001). Additionally, the prognostic ability of PNI was not affected by subgroup analysis factors.ConclusionThe meta-analysis indicated that low PNI associated with shorter survival outcomes in patients with RCC. Therefore, PNI could be used as an effective prognostic indicator in RCC.

scholarly journals A 2/1 sunitinib dosing schedule provides superior antitumor effectiveness and less toxicity than a 4/2 schedule for metastatic renal cell carcinoma: A systematic review and meta-analysis

2019 ◽  
Author(s):  
Huan Deng ◽  
Lianli Zeng ◽  
Qian Wu ◽  
Li Wang ◽  
Zhengdong Hong ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Large Scale ◽  
Meta Analysis ◽  
Objective Response ◽  
Initial Dosage ◽  
Cochrane Library ◽  
Platelet Disorder

Abstract Background The standard sunitinib schedule to treat metastatic renal cell carcinoma (mRCC) is 4 weeks on/2 weeks off (4/2). However, some studies revealed intolerable adverse events (AEs) in patients on this schedule. An alternative schedule, 2 weeks on/1 week off (2/1), may overcome this issue. This meta-analysis was performed to compare the effectiveness and toxicity between the 2/1 and 4/2 sunitinib dosing schedules. Methods We acquired relevant studies by searching PubMed, ScienceDirect, the Cochrane Library, Scopus, Ovid MEDLINE, Embase, Web of Science, and Google Scholar. Our main endpoints included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and AEs. Results We identified 9 medium- and high-quality studies. Both schedules were effective for mRCC, with comparable OS and similar ORR. However, the 2/1 schedule had better PFS (hazard ratio (HR) = 0.81, 95% confidence interval [CI]: 0.66-0.99, P= 0.04), higher DCR (risk rate (RR) = 1.22, 95% CI: 1.01-1.47, P= 0.04) and fewer dosage interruptions (RR= 0.60, 95% CI: 0.43-0.84, P= 0.003). Additionally, the 2/1 schedule elicited fewer specific severe AEs, including thrombocytopenia/platelet disorder, hand-foot syndrome, hypertension and fatigue. In our subanalysis, PFS was better among East Asians using the 2/1 schedule than among other populations (HR= 0.75, 95% CI: 0.58-0.98, P= 0.03), and patients administered an initial dosage of 50 mg/d on the 2/1 schedule had superior PFS (HR= 0.76, 95% CI: 0.59-0.97, P= 0.03) than those others. Conclusions These findings suggest that the 2/1 schedule is more suitable for mRCC than 4/2, due to superior PFS, better DCR and fewer AEs. Nevertheless, more large-scale studies with good quality are needed.

scholarly journals Comparative Efficacy of First-Line Immune-Based Combination Therapies in Metastatic Renal Cell Carcinoma. A Systematic Review and Network Meta-Analysis.

2020 ◽  
Author(s):  
Reza ELAIDI ◽  
Letuan PHAN ◽  
Delphine Borchiellini ◽  
Philippe BARTHELEMY ◽  
Alain Ravaud ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Objective Response Rate ◽  
Response Rate ◽  
Meta Analysis ◽  
Objective Response ◽  
Cochrane Library ◽  
First Line

Background: Three drug-combinations, ipilimumab-nivolumab (Ipi-Nivo), pembrolizumab-axitinib (Pembro-Axi) and avelumab-axitinib (Ave-Axi), have received regulatory approvals in USA and Europe for the treatment of metastatic renal cell carcinoma with clear cell component (mRCC). However, no head-to-head comparison data are available to identify the best option. Therefore, we aimed to compare these new treatments in the first-line setting. Methods: We conducted a systematic search in Pubmed, the Cochrane library and clinicaltri-al.gov website from January 2015 to October 2019, for any randomized controlled trials of treatment-naïve patients with mRCC. The process was performed according to PRISMA guide-lines. We performed a Bayesian network meta-analysis with two different approaches. The out-comes for analysis were overall survival, progression-free survival, and objective response rate. Results: Our search identified 3 published phase 3 randomized clinical trials (2835 patients). In the contrast-based model, Ave-Axi (SUCRA: 83%) and Pembro-Axi (SUCRA: 80%) exhibited the best ranking probabilities for PFS. For OS, Pembro-Axi (SUCRA: 96%) was the most pref-erable option against Ave-Axi and Ipi-Nivo. Objective response rate analysis showed Ave-Axi as the best (SUCRA= 94%) and Pembro-Axi as second best option. In the parametric models, risk of progression was comparable for Ave-Axi and Ipi-Nivo, whereas Pembro-Axi exhibited a lower risk during the first 6 months of treatment and a higher risk afterward. Furthermore, Pembro-Axi exhibited a net advantage in terms of OS over the two other regimens, while Ave-Axi was the least preferable option. Conclusions: Overall evidences suggested pembrolizumab plus axitinib may be the best option.

A systematic review and network meta-analysis of first-line treatment options in patients metastatic renal cell carcinoma.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 709-709
Author(s):  
Irbaz Bin Riaz ◽  
Alexander J. Ryu ◽  
Yuan Yao ◽  
Rabbia Siddiqi ◽  
Jessey Mathew ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Significant Interaction ◽  
Meta Analysis ◽  
Treatment Options ◽  
Cochrane Library ◽  
First Line ◽  
Grade 3

709 Background: Several immunotherapy (IMT) combinations either as an IMT doublet or IMT in combination with TKIs are now available for first-line therapy of metastatic renal cell carcinoma (mRCC). In the absence of head-to-head clinical trials, we performed an indirect comparison of frontline treatment options to provide clinical guidance. Methods: Medline, Embase and Cochrane Library were searched to identify relevant trials. Hazard ratios (HR) and confidence interval (CI) for primary outcome of progression-free survival (PFS) and secondary outcome of overall survival (OS) were abstracted. Network meta-analysis was performed using a multivariate, consistency model, random-effects meta-regression. Data on Grade 3 or higher AEs was abstracted and meta-analyzed. Pre-specified subgroup analyses were performed based on risk categories (high risk vs low and intermediate vs), history of prior nephrectomy, PD-L1 positivity, age and sex. Risk for bias(RoB) was assessed using the Cochrane Collaboration’s tool. Results: Nine studies were included for PFS analysis, and 6 studies for OS analysis. Avelumab-axitinib (AA) (HR 0.69, 0.48-0.96), and Pembrolizumab-Axitinib (PA) (HR 0.89, 0.50-0.96) significantly improved PFS, while there was no significant PFS benefit with atezolizumab-bevacizumab (AB) (HR 0.83, 0.62-1.13) and nivolumab-ipilimumab (NI) (HR 0.85, 0.63-1.15) as compared to Sunitinib. PA (HR 0.53, 0.38-0.75) and NI (HR 0.63, 0.44-0.90) significantly improved OS, while AB (HR 0.93, 0.75-1.12) showed no significant OS benefit as compared to Sunitinib. NI and AB had significantly fewer grade ≥3 AE than sunitinib. No significant interaction was found by risk group, age, sex or prior nephrectomy. Significant interaction was found by PD-L1 expression(p<0.001), with significant PFS improvement in PD-L1 positive (HR 0.62, 0.53-0.73) but not in PD-L1 negative patients (HR 0.92, 0.81-1.05). Overall, RoB was low amongst included studies. Conclusions: AA improved PFS, NI improved OS, whereas PA improve both PFS and OS as compared to sunitinib monotherapy. However, no IMT combination was superior to other combinations. Cost effectiveness analysis will be reported separately.

scholarly journals Diagnostic Performance of MRI, SPECT, and PET in Detecting Renal Cell Carcinoma: A Meta-Analysis

2021 ◽  
Author(s):  
Qihua Yin ◽  
Huiting Xu ◽  
Yanqi Zhong ◽  
Jianming Ni ◽  
Shudong Hu
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Likelihood Ratio ◽  
Renal Cell ◽  
Meta Analysis ◽  
Positive Likelihood Ratio ◽  
Cochrane Library ◽  
Emission Computed Tomography ◽  
Sensitivity Specificity ◽  
Metastatic Rcc

Abstract Background: Renal cell carcinoma (RCC) is one of the most common malignancies worldwide. Noninvasive imaging techniques, such as magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET), have been involved in increasing evolution to detect RCC. This meta-analysis aims to compare to compare the value of MRI, SPECT, and PET in the diagnosis of RCC, and to provide evidence for decision-making in terms of further research and clinical settings.Methods: Electronic databases including PubMed, Web of Science, Embase, and Cochrane Library were systemically searched. Studies concerning MRI, SPECT, and PET for the detection of RCC were included. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), with their respective 95% confidence interval (CIs) and the area under the summary receiver operating characteristic (SROC) curve (AUC) were calculated.Results: A total of 44 articles were finally detected for inclusion in this meta-analysis. The pooled sensitivities of MRI, SPECT, and PET were 0.80, 0.81, and 0.88, respectively. Their respective overall specificities were 0.90, 0.54, and 0.87. Results in the subgroup analysis of the performance of SPECT that the pooled sensitivity, specificity, and AUC of the prospective SPECT studies included were 0.80, 0.42, 0.80, respectively. In the analysis of 18F-FDG PET, the pooled sensitivity, specificity, and AUC were 0.88, 0.86, and 0.92, respectively. PET studies showed a pooled sensitivity, specificity, and AUC of 0.80, 0.85, and 0.85, respectively in the diagnosis of primary RCC. The pooled sensitivity, specificity, and AUC of PET studies in detecting recurrent or metastatic RCC were 0.93, 0.88, and 0.94.Conclusion: Our meta-analysis manifests that MRI and PET present better diagnostic value for the detection of RCC in comparison with SPECT. PET is superior in the diagnosis of recurrent or metastatic RCC.

scholarly journals Preoperative systemic immune-inflammation index predicts prognosis of patients with non-metastatic renal cell carcinoma: a propensity score-matched analysis

2020 ◽  
Author(s):  
Xu Hu ◽  
Yan-Xiang Shao ◽  
Zhi-Qiang Yang ◽  
Wei-Chao Dou ◽  
San-Chao Xiong ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Propensity Score ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Independent Predictor ◽  
Prognostic Significance ◽  
Cox Regression Analysis ◽  
Immune Inflammation ◽  
Metastatic Rcc

Abstract Background: A novel systemic immune-inflammation index (SII), based on the neutrophils, lymphocytes and platelet counts, is associated with the prognosis of several cancers. The present study evaluates the prognostic significance of SII in non-metastatic renal cell carcinoma (RCC).Method: The present study retrospectively reviewed the medical record of patients with non-metastatic RCC who underwent nephrectomy between 2010 and 2013. Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cut-off value. In addition, the propensity score matching (PSM) was performed with a matching ratio of 1:1. Univariate and multivariate Cox proportional hazards models were used to identify the prognostic factors. The results were reported by hazard ratio (HR) with 95% confidence interval (95% CI). Results: A total of 646 patients were included in the final analysis. High SII group (>529) was significantly associated with older age (P=0.014), larger tumor (P<0.001), higher pathological T stage (P<0.001), higher tumor grade (P<0.001) and more tumor necrosis (P<0.001). Multivariate Cox regression analysis demonstrated that the higher preoperative SII was significantly associated with worse overall survival (OS) (HR=2.26; 95%CI 1.44-3.54; P<0.001) and cancer-specific survival (CSS) (HR=2.17; 95%CI 1.33-3.55; P=0.002). After PSM, elevated preoperative SII was an independent predictor of poor OS (HR=1.78; 95%CI 1.1-2.87; P=0.018) and CSS (HR=1.8; 95%CI 1.07-3.03; P=0.027).Conclusion: In conclusion, preoperative SII is associated with adverse factors for RCC. Furthermore, higher preoperative SII is an independent predictor of poor OS and CSS in surgically treated patients with non-metastatic RCC. More prospective and large scale studies are warranted to validate our findings.

Sign in / Sign up

Export Citation Format

Share Document