Inflammatory prognostic index score as a new parameter predicting overall survival in renal cell carcinoma

Abstract

Background/Aim: The importance of prognostic markers in the treatment and follow-up of metastatic renal cell carcinoma is gradually increasing. Currently used markers do not meet the exact needs in this regard. In this study, we evaluated the predictive and prognostic values of inflammatory prognostic index (IPI) scoring in metastatic Renal cell carcinoma (RCC) patients. In IPI scoring, we used four biochemical parameters related to inflammation, including albumin, CRP, neutrophils, and lymphocytes. Methods: Medical records of fifty-seven patients with RCC treated in Celal Bayar University Medical Faculty Hospital Medical Oncology Clinic between February 2012 and April 2019 were retrospectively reviewed. The IPI was calculated as C-reactive protein × NLR (neutrophil/lymphocyte ratio)/serum albumin. Univariate and multivariate analyses were performed to assess the prognostic value of relevant factors. Results: The cut-off value for IPI in predicting mortality was 1.03 according to ROC curve analysis. Median OS of the patients with IPI ≥1.03 was 8 months (95 %Cl 3-10.9). The relationship between overall survival and IPI score was remarkable. According to this analysis, comorbidity, metastasis to the lung, liver, lymph nodes, bone, the number of metastatic sites (one metastatic area), high NLR, high IPI were also significantly associated with OS (P<0.05 for each). In multivariate analyses, IPI was an independent prognostic factor in RCC. Patients with high IPI (>1.03) had an increased mortality risk compared to those with low IPI (<1.03) (HR: 8.5; 95 %CI, 2.303-31.42; P<0.001). Comorbidity, lung metastasis, lymph nodes and bone metastasis, high NLR, IMDC risk also independently predicted worse OS in RCC. Conclusion: The relationship between many inflammatory markers, such as NLR and RCC, and overall survival was proven earlier, while the relationship with IPI is discussed for the first time. We would like to discuss the findings we obtained in our study in the light of other analyses in the literature investigating the relationship between other inflammation markers and RCC. IPI may be an easily accessible and independent prognostic index for RCC patients, and useful for clinical practice.