Expression of PD-1 and CTLA-4 Are Negative Prognostic Markers in Renal Cell Carcinoma

Immuno-oncological therapy with checkpoint inhibition (CI) has become a new standard treatment in metastatic renal cell carcinoma (RCC), but the prognostic value of the expression of CI therapy target molecules is still controversial. 342 unselected consecutive RCC tumor samples were analyzed regarding their PD-1, PD-L1, and CTLA-4 expression by immunohistochemistry (IHC). The prognostic values for cancer-specific survival (CSS) and overall survival (OS) were analyzed for those not exposed to CI therapy. The expression of PD-1 in tumor-infiltrating mononuclear cells (TIMC) and PD-L1 in tumor cells was detected in 9.4% and 12.3%, respectively (Immune reactive score (IRS) > 0). Furthermore, PD-L1 expression in TIMC (IRS > 0) and CTLA-4 expression in TIMC (>1% positive cells) was detected in 4.8% and 6.3%. PD-1 expression and CTLA-4 expression were significantly associated with a worse OS and CSS in log rank survival analysis and univariate Cox regression analysis. CTLA-4 expression is a prognostic marker that is independently associated with a worse outcome in multivariate Cox regression analysis in the whole cohort (OS: p = 0.013; CSS: p = 0.048) as well as in a non-metastatic subgroup analysis (OS: p = 0.028; CSS: p = 0.022). Patients with combined CTLA-4 expression and PD-1-expression are at highest risk in OS and CSS. In RCC patients, PD-1 expression in TIMC and CTLA-4 expression in TIMC are associated with a worse OS and CSS. The combination of PD-1 expression in TIMC and CTLA-4 expression in TIMC might identify high risk patients. This is, to our knowledge, the first description of CTLA-4 expression to be a prognostic marker in RCC.

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Metabolic genes show excellent prognostic ability for clear cell renal cell carcinoma

10.21203/rs.3.rs-25880/v1 ◽

2020 ◽

Author(s):

Chengjian Ji ◽

Yichun Wang ◽

Liangyu Yao ◽

Jiaochen Luan ◽

Rong Cong ◽

...

Keyword(s):

Gene Expression ◽

Renal Cell Carcinoma ◽

Regression Analysis ◽

Cell Carcinoma ◽

Renal Cell ◽

Cox Regression ◽

Expression Profiles ◽

Cell Renal Cell Carcinoma ◽

Cox Regression Analysis ◽

Metabolic Genes

Abstract Background Renal cell carcinoma (RCC) is one of the major malignant tumors of the urinary system, with a high mortality rate and a poor prognosis. Clear cell renal cell carcinoma (ccRCC) is the most common subtype of RCC. Although the diagnosis and treatment methods have been significantly improved, the incidence and mortality of ccRCC are high and still increasing. The occurrence and development of ccRCC are closely related to the changes of classic metabolic pathways. This article aims to explore the relationship between metabolic genes and the prognosis of patients with ccRCC. Patients and methods: Gene expression profiles of 63 normal kidney tissues and 446 ccRCC tissues from TCGA database and gene expression profiles of 39 ccRCC tissues from GEO database were used to obtain differentially expressed genes (DEGs) in ccRCC. Through the the KEGG gene sets of GSEA database, we obtained metabolic genes (MGs). Univariate Cox regression analysis was used to identify prognostic MGs. Lasso regression analysis was used to eliminate false positives because of over-fitting. Multivariate Cox regression analysis was used to established a prognostic model. Gene expression data and related survival data of 101 ccRCC patients from ArrayExpress database were used for external validation. Survival analysis, ROC curve analysis, independent prognostic analysis and clinical correlation analysis were performed to evaluate this model. Results We found that there were 479 abnormally expressed MGs in ccRCC tissues. Through univariate Cox regression analysis, Lasso regression analysis and multivariate Cox regression analysis, we identified 4 prognostic MGs (P4HA3, ETNK2, PAFAH2 and ALAD) and established a prognostic model (riskScore). Whether in the training cohort, the testing cohort or the entire cohort, this model could accurately stratify patients with different survival outcomes. The prognostic value of riskScore and 4 MGs was also confirmed in the ArrayExpress database. Results of GSEA analysis show that DEGs in patients with better prognosis were enriched in metabolic pathways. Then, a new Nomogram with higher prognostic value was constructed to better predict the 1-year OS, 3-year OS and 5-year OS of ccRCC patients. In addition, we successfully established a ceRNA network to further explain the differences in the expression of these MGs between high-risk patients and low-risk patients Conclusion We have successfully established a risk model (riskScore) based on 4 MGs, which could accurately predict the prognosis of patients with ccRCC. Our research may shed new light on ccRCC patients' prognosis and treatment management.

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Clinical Significance of Pre-to-Postoperative Dynamics of Aspartate Transaminase/Alanine Transaminase Ratio in Predicting the Prognosis of Renal Cell Carcinoma after Surgical Treatment

Disease Markers ◽

10.1155/2020/8887605 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Minyong Kang ◽

Seung Jea Shin ◽

Hyun Hwan Sung ◽

Hwang Gyun Jeon ◽

Byong Chang Jeong ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Prognostic Factor ◽

Cell Carcinoma ◽

Renal Cell ◽

Radical Nephrectomy ◽

Cox Regression ◽

Significant Prognostic Factor ◽

Cancer Specific Survival ◽

Cox Regression Analysis ◽

Group 2

Background. This study is aimed at examining the prognostic role of pre-to-postoperative dynamics of De Ritis ratio (aspartate aminotransaminase (AST)/alanine aminotransaminase (ALT)) in patients with nonmetastatic renal cell carcinoma (RCC) following radical nephrectomy. Methods. We retrospectively reviewed the records of 670 patients who underwent radical nephrectomy for nonmetastatic RCC between 1996 and 2012 at our institution. The cutoff points for preoperative (=1.0) and postoperative AST/ALT ratios (=1.12) were assigned based on the median values. We categorized patients into four groups according to the dynamics of AST/ALT ratios: group 1 (lower (≤1.0) ⟶ lower (≤1.12)), group 2 (lower (≤1.0) ⟶ higher (>1.12)), group 3 (higher (>1.0) ⟶ lower (≤1.12)), and group 4 (higher (>1.0) → higher (>1.12)). Results. When grouped by a preoperative AST/ALT ratio alone, the groups were not statistically different in cancer-specific survival (CSS) or overall survival (OS). In contrast, in Kaplan-Meier analysis, CSS (P=0.0296) and OS (P=0.0324) were both significantly shorter with an increased postoperative AST/ALT ratio. According to the pre-to-postoperative dynamics of the AST/ALT ratio, group 2 (lower (≤1.0) ⟶ higher (>1.12)) had a significantly lower CSS (P=0.0028) and OS (P=0.0194) than the other groups. On multivariate Cox regression analysis, the pre-to-postoperative dynamics of the AST/ALT ratio were a significant prognostic factor for CSS (hazard ratio, HR=3.45) and OS (HR=2.18). Conclusion. This study is the first to suggest that the dynamics of the pre-to-postoperative De Ritis ratio represent an independent prognostic factor for RCC patients following nephrectomy.

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Identification of an Independent Immune-genes Prognostic Index for Renal Cell Carcinoma

10.21203/rs.3.rs-111386/v1 ◽

2020 ◽

Author(s):

Chao Qin ◽

Guangyao Li ◽

Xiyi Wei ◽

Shifeng Su ◽

Shangqian Wang ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Regression Analysis ◽

Cell Carcinoma ◽

Risk Score ◽

Renal Cell ◽

Cox Regression ◽

Immune Gene ◽

Cox Regression Analysis ◽

Immune Genes ◽

Score Model

Abstract Objective: Increasing evidence has indicated an association between immune micro-environment in clear cell renal cell carcinoma (ccRCC) and clinical outcomes. The aim of this research is to comprehensively investigate the effect of tumor immune genes on the prognosis of ccRCC patients. Methods: 2498 immune genes were downloaded from ImmPort database. Additionally, we identified and downloaded the transcriptome data of patients with ccRCC from the TCGA database through the R package, as well as relevant clinical information. We apply certain survival R package to analyse the survival of hub-genes before analyzing the effect of immune genes on the prognosis of clear cell renal cell carcinoma (ccRCC) utilizing Cox regression analysis. Based on the statistical correlation between hub immune gene and survival ,immune risk score model was set up.We finally constructed a nomogram to predict the survival rate of ccRCC overally. In addition, whether the immune gene risk score model is an independent prognostic factor for ccRCC is comprehensively considered applying multivariate cox regression analysis. It is worth noting that throughout the data analysis, P< 0.05 was recognized to be of significance statistically. Results: The results of the difference analysis showed that 556 immune genes exhibited differential expression between normal and ccRCC tissues (p<0. 05). Univariate cox regression analysis revealed 43 immune genes statistically correlated with ccRCC related survival risk (P<0.05). In addition, a 18-genes based immune genes risk scoring model was constructed through lasso COX regression analysis. KM curve indicated that patients in high-risk were associated with poor outcomes (p<0.001). ROC curve indicated that the immune risk score model was reliable in predicting survival risk (5-year OS, AUC=0.802). Our model showed satisfying AUC and survival correlation in the validation dataset ( 5-year OS AUC=0.705, P<0.001). Furthermore, multivariate cox regression analysis confirmed that the immune risk score model was an independent factor for predicting the prognosis of ccRCC. A nomogram was established to comprehensively predict the survival of ccRCC patients with the results of multivariate cox regression analysis. Finally, we found that 15 immune genes and risk scores were significantly associated with clinical factors and prognosis, and were involved in multiple oncogenic pathways.Conclusion: Collectively, tumor immune genes played an essential role in the prognosis of ccRCC. Furthermore, immune risk score was an independent predictive factor of ccRCC, indicating a poor survival.

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Increased Expression of TICRR Predicts Poor Clinical Outcomes: A Potential Therapeutic Target for Papillary Renal Cell Carcinoma

Frontiers in Genetics ◽

10.3389/fgene.2020.605378 ◽

2021 ◽

Vol 11 ◽

Author(s):

Shuang Xia ◽

Yan Lin ◽

Jiaqiong Lin ◽

Xiaoyong Li ◽

Xuexian Tan ◽

...

Keyword(s):

Cell Cycle ◽

Renal Cell Carcinoma ◽

Regression Analysis ◽

Cell Carcinoma ◽

Clinical Outcomes ◽

Renal Cell ◽

Cox Regression ◽

Papillary Renal Cell Carcinoma ◽

Cox Regression Analysis ◽

Clinical Stages

Background: Papillary renal cell carcinoma (PRCC), although the second-most common type of renal cell carcinoma, still lacks specific biomarkers for diagnosis, treatment, and prognosis. TopBP1-interacting checkpoint and replication regulator (TICRR) is a DNA replication initiation regulator upregulated in various cancers. We aimed to evaluate the role of TICRR in PRCC tumorigenesis and prognosis.Methods: Based on the Kidney Renal Papillary cell carcinoma Project (KIRP) on The Cancer Genome Atlas (TCGA) database, we determined the expression of TICRR using the Wilcoxon rank sum test. The biological functions of TICRR were evaluated using the Metascape database and Gene Set Enrichment Analysis (GSEA). The association between TICRR and immune cell infiltration was investigated by single sample GSEA. Logistic analysis was applied to study the correlation between TICRR expression and clinicopathological characteristics. Finally, Cox regression analysis, Kaplan–Meier analysis, and nomograms were used to determine the predictive value of TICRR on clinical outcomes in PRCC patients.Results:TICRR expression was significantly elevated in PRCC tumors (P < 0.001). Functional annotation indicated enrichment with negative regulation of cell division, cell cycle, and corresponding pathways in the high TICRR expression phenotype. High TICRR expression in PRCC was associated with female sex, younger age, and worse clinical stages. Cox regression analysis revealed that TICRR was a risk factor for overall survival [hazard ratio (HR): 2.80, P = 0.002], progression-free interval (HR: 2.86, P < 0.001), and disease-specific survival (HR: 7.03, P < 0.001), especially in patients with male sex, age below 60 years, clinical stages II–IV and clinical T stage T1–T2.Conclusion: Increased TICRR expression in PRCC might play a role in tumorigenesis by regulating the cell cycle and has prognostic value for clinical outcomes.

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Prognostic value and immunological role of AXL gene in clear cell renal cell carcinoma associated with identifying LncRNA/RBP/AXL mRNA networks

Cancer Cell International ◽

10.1186/s12935-021-02322-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yi Wang ◽

Ye Tian ◽

Shouyong Liu ◽

Zengjun Wang ◽

Qianwei Xing

Keyword(s):

Renal Cell Carcinoma ◽

Regression Analysis ◽

Cell Carcinoma ◽

Renal Cell ◽

Cox Regression ◽

Clear Cell ◽

Gene Set Enrichment Analysis ◽

Cell Renal Cell Carcinoma ◽

Cox Regression Analysis ◽

Tcga Dataset

Abstract Backgrounds This article aimed to explore the prognostic and immunological roles of AXL gene in clear cell renal cell carcinoma (ccRCC) for overall survival (OS) and to identify the LncRNA/RBP/AXL mRNA networks. Methods AXL-related gene expression matrix and clinical data were obtained from The Cancer Genome Atlas (TCGA) dataset and AXL-related pathways were identified by gene set enrichment analysis (GSEA). We performed univariate/multivariate Cox regression analysis to evaluate independent prognostic factors and the relationships between AXL and immunity were also investigated. Results The outcomes of us indicated that the AXL mRNA expression was up-regulated in ccRCC samples and high expression of AXL was associated with worse OS in TCGA dataset (P < 0.01). Further external verification results from HPA, UALCAN, ICGC dataset, GSE6344, GSE14994, and qRT-PCR remained consistent (all P < 0.05). AXL was also identified as an independent prognostic factor for ccRCC by univariate/multivariate Cox regression analysis (both P < 0.05). A nomogram including AXL expression and clinicopathological factors was established by us and GSEA results found that elevated AXL expression was associated with the JAK-STAT, P53, WNT, VEGF and MAPK signaling pathways. In terms of immunity, AXL was dramatically linked to tumor microenvironment, immune cells, immune infiltration, immune checkpoint molecules and tumor mutational burden (TMB). As for its potential mechanisms, we also identified several LncRNA/RBP/AXL mRNA axes. Conclusions AXL was revealed to play prognostic and immunological roles in ccRCC and LncRNA/RBP/AXL mRNA axes were also identified by us for its potential mechanisms.

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The prognostic value of fat invasion and tumor expansion in the hilar veins in pT3a renal cell carcinoma

World Journal of Urology ◽

10.1007/s00345-021-03638-0 ◽

2021 ◽

Author(s):

Viktoria Stühler ◽

Steffen Rausch ◽

Katharina Kroll ◽

Marcus Scharpf ◽

Arnulf Stenzl ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Prognostic Value ◽

Cox Regression ◽

Tnm Classification ◽

Cancer Specific Survival ◽

Cox Regression Analysis ◽

The Difference ◽

Risk Of Cancer

Abstract Purpose The 7th TNM classification summarizes renal cell carcinoma (RCC) with perirenal (PFI) and/or sinus fat invasion (SFI) as well as hilar vein involvement (RVI) as pT3a tumors. In this study, we aimed to determine the prognostic value of fat invasion (FI) in the different compartments and RVI for medium-term cancer-specific-survival (CSS) in pT3a RCC. Materials and methods Patients with pT3a RCC were identified using an institutional database. All original pathological reports were reclassified according to the 7th TNM edition. The prognostic value of FI as well as divided into PFI, SFI, combined PFI + SFI, and RVI for CSS was assessed using univariate and multivariate Cox-regression analysis. Survival was estimated using the Kaplan–Meier method. Results Median follow-up in 184 pT3a tumors was 38 months. FI was detectable in 153 patients (32.7% PFI, 45.1% SFI, 22.2% PFI + SFI), 31 patients showed RVI alone. Combined PFI + SFI increased the risk of cancer-related death compared to PFI (HR 3.11, p < 0.01), SFI (HR 1.84, p = 0.023) or sole RVI (HR 2.12, p = 0.025). In multivariate analysis, a combined PFI + SFI vs. PFI or SFI as the only compartment involved was confirmed as independent prognostic factor (HR 1.83, p = 0.029). Patients with FI and simultaneous RVI had significantly shorter CSS (HR 2.63, p < 0.01). In an unweighted model, the difference between patients with combined PFI + SFI and RVI and those with PFI alone was highest (HR 4.01, p = 0.029). Conclusions These results underline the subdivision of pT3a RCC depending on the location of FI and RVI for patient stratification.

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Interleukin-4 Promoter Polymorphisms: A Genetic Prognostic Factor for Survival in Metastatic Renal Cell Carcinoma

Journal of Clinical Oncology ◽

10.1200/jco.2006.07.8154 ◽

2007 ◽

Vol 25 (7) ◽

pp. 845-851 ◽

Cited By ~ 33

Author(s):

Thomas Kleinrath ◽

Christoph Gassner ◽

Peter Lackner ◽

Martin Thurnher ◽

Reinhold Ramoner

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Cox Regression ◽

Clinical Course ◽

Prognostic Significance ◽

Interleukin 4 ◽

Promoter Polymorphisms ◽

Cox Regression Analysis ◽

Metastatic Rcc

Purpose Renal cell carcinoma (RCC) is considered a cytokine-responsive tumor. The clinical course of a patient may thus be influenced by the patient's capacity to produce distinct cytokines. Therefore, cytokine gene polymorphisms in RCC patients were analyzed to determine haplotype combinations with prognostic significance. Patients and Methods A selection of 21 single nucleotide polymorphisms within the promoter regions of 13 cytokine genes were analyzed in a cross-sectional single-center study of 80 metastatic RCC patients. Univariate and multivariate analyses and the Cox forward-stepwise regression model were chosen to assess genetic risk factors. Results Multivariate Cox regression analysis confirmed by a bootstrap technique identified the heterozygous IL4 genotype −589T−33T/−589C−33C as an independent prognostic risk factor (risk ratio, 3.1; P < .01; 95% CI, 1.4 to 6.9; adjusted for age, sex, and nuclear grading) in metastatic RCC patients. IL4 haplotype −589T−33T and −589C−33C were found with a frequency of 0.069 and 0.925, respectively, which represents a two-fold decrease of IL4 haplotype −589T−33T (P < .01) and an increase of IL4 haplotype −589C−33C frequency (P < .05) in metastatic RCC compared with other white reference study populations. The median overall survival was decreased 3.5-fold (P < .05) in heterozygote patients carrying IL4 haplotype −589T−33T and −589C−33C (3.78 months) compared with patients homozygote for IL4 haplotype −589C−33C (13.44 months). In addition, a linkage disequilibrium between the IL4 gene and the KIF3A gene was detected. Conclusion Our findings indicate that IL4 promoter variants influence prognosis in patients with metastatic RCC and suggest that genetically determined interleukin-4 (IL-4) production affects the clinical course of the disease possibly through regulation of immune surveillance.

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Second-line VEGF TKI after IO combination therapy: Results from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.684 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 684-684

Author(s):

Igor Stukalin ◽

Shaan Dudani ◽

Connor Wells ◽

Chun Loo Gan ◽

Sumanta K. Pal ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Combination Therapy ◽

Cell Carcinoma ◽

Metastatic Renal Cell Carcinoma ◽

Renal Cell ◽

Cox Regression ◽

Response Rates ◽

Second Line ◽

First Line ◽

Cox Regression Analysis

684 Background: Immuno-Oncology (IO) combinations are standard of care first-line treatment for metastatic renal cell carcinoma (mRCC). Data on therapy with vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors (TKI) post-progression on IO-combination therapy are limited. Methods: Using the IMDC, a retrospective analysis was done on mRCC patients treated with second-line VEGF TKIs after receiving IO combination therapy. Patients received first-line ipilimumab+nivolumab (IOIO) or anti-PD(L)1+anti-VEGF (IOVE). Baseline variables and second-line IMDC risk factors were collected. Overall response rates (ORR), time to treatment failure (TTF) and overall survival (OS) were determined. Multivariable Cox regression analysis was performed. Results: 142 patients were included. 75 patients received IOIO and 67 received IOVE pretreatment. The ORR of 2nd line therapy was 17/46 (37%) and 7/57 (12%) in the IOIO and IOVE pretreated groups, respectively (p<0.01). 2nd-line TTF was 5.4 months (95% CI 4.1-8.3) for the IOIO- and 4.6 months (95% CI 3.7-5.8) for the IOVE-pretreated group (p=0.37). 2nd-line median OS was 17.2 months (95% CI 10.8-35.1) and 11.8 months (95% CI 9.9-21.3) for the prior IOIO and IOVE groups, respectively (p=0.13). The hazard ratio adjusted by IMDC for IOVE vs IOIO pretreatment was 1.22 (95% CI 0.73-2.07, p=0.45) for 2nd line TTF and 1.43 (95% CI 0.74-2.8, p=0.29) for 2nd line OS. Conclusions: VEGF TKIs show activity after combination IO therapy. Response rates are higher in patients treated with VEGF TKIs after first-line IOIO compared to after IOVE. In patients with VEGF TKI after IOIO or IOVE, no difference in OS and TTF was observed.[Table: see text]

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rs3200401 MALAT1 GENE POLYMORPHISM IS NOT RELATED TO AGE OF KIDNEY CANCER ONSET

Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії ◽

10.31718/2077-1096.20.2.119 ◽

2020 ◽

Vol 20 (2) ◽

pp. 119-123

Author(s):

A.D. Volkohon ◽

V. Yu. Harbuzova ◽

O.V. Ataman

Keyword(s):

Renal Cell Carcinoma ◽

Gene Polymorphism ◽

Cell Carcinoma ◽

Kidney Cancer ◽

Renal Cell ◽

Cox Regression ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Non Coding Rna ◽

Long Non Coding Rna

Today, the long non-coding RNA MALAT1 is considered to be one of the major RNAs involved in the emergence and metastasizing of various malignant tumours. Recent experiments have shown that MALAT1 plays an important role in the onset and progression of kidney cancer as well. It was found that cancer patient survival depends on the level of MALAT1 gene expression. The aim of the study was to investigate the possible association between rs3200401 MALAT1 gene polymorphism and age of kidney cancer onset among Ukrainian patients. Materials and methods. The venous blood of 101 patients with clear cell renal cell carcinoma (42 women and 59 men) was used for study. Determination of MALAT1 gene rs320040 polymorphism was performed by the Real-Time polymerase chain reaction method using TaqManSNP Assay C_3246069_10 components. Statistical analysis of the data obtained was performed using SPSS (version 17.0). To test the possible association between rs3200401 genotypes and the age of kidney cancer onset Kaplan-Meier and Cox regression techniques were used. P value < 0.05 was considered as statistically significant. Results. The obtained results of MALAT1 gene rs3200401 polymorphic site genotyping revealed that 71 (70.3%) patients with renal cell carcinoma had CC genotype, 29 (28.7%) – CT, 1 (1%) – TT genotype. Survival analysis by Kaplan-Meier method showed that life expectancy until the tumour occurrence was not related to rs3200401 locus (log rank P = 0.449 – for codominant model; log rank P = 0.847 – for dominant model). The results of Cox regression analysis also showed no link between MALAT gene rs3200401-site and risk of renal cell carcinoma development (P > 0.05). No statistically significant results were found after adjustment for sex, body mass index, metastasis, smoking and drinking habits (P > 0.05). Conclusions. The rs3200401 gene polymorphism of long non-coding RNA MALAT1 is not associated with the age of kidney cancer onset in Ukrainian population.

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Combination of Albumin-Globulin Score and Sarcopenia to Predict Prognosis in Patients With Renal Cell Carcinoma Undergoing Laparoscopic Nephrectomy

Frontiers in Nutrition ◽

10.3389/fnut.2021.731466 ◽

2021 ◽

Vol 8 ◽

Author(s):

Weipu Mao ◽

Nieke Zhang ◽

Keyi Wang ◽

Qiang Hu ◽

Si Sun ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Cox Regression ◽

Training Set ◽

Test Set ◽

Cox Regression Analysis ◽

Inflammatory Status ◽

Grade 3 ◽

The Impact

We conducted a multicenter clinical study to construct a novel index based on a combination of albumin-globulin score and sarcopenia (CAS) that can comprehensively reflect patients' nutritional and inflammatory status and assess the prognostic value of CAS in renal cell carcinoma (RCC) patients. Between 2014 and 2019, 443 patients from 3 centers who underwent nephrectomy were collected (343 in the training set and 100 in the test set). Kaplan-Meier curves were employed to analyze the impact of albumin-globulin ratio (AGR), albumin-globulin score (AGS), sarcopenia, and CAS on overall survival (OS) and cancer-specific survival (CSS) in RCC patients. Receiver operating characteristic (ROC) curves were used to assess the predictive ability of AGR, AGS, sarcopenia, and CAS on prognosis. High AGR, low AGS, and nonsarcopenia were associated with higher OS and CSS. According to CAS, the training set included 60 (17.5%) patients in grade 1, 176 (51.3%) patients in grade 2, and 107 (31.2%) patients in grade 3. Lower CAS was linked to longer OS and CSS. Multivariate Cox regression analysis revealed that CAS was an independent risk factor for OS (grade 1 vs. grade 3: aHR = 0.08; 95% CI: 0.01–0.58, p = 0.012; grade 2 vs. grade 3: aHR = 0.47; 95% CI: 0.25–0.88, p = 0.018) and CSS (grade 1 vs. grade 3: aHR = 0.12; 95% CI: 0.02–0.94, p = 0.043; grade 2 vs. grade 3: aHR = 0.31; 95% CI: 0.13–0.71, p = 0.006) in RCC patients undergoing nephrectomy. Additionally, CAS had higher accuracy in predicting OS (AUC = 0.687) and CSS (AUC = 0.710) than AGR, AGS, and sarcopenia. In addition, similar results were obtained in the test set. The novel index CAS developed in this study, which reflects patients' nutritional and inflammatory status, can better predict the prognosis of RCC patients.

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