Cancer Management and Research (Oct 2020)

Combination of Hematology Indicators and Oncological Characteristics as a New Promising Prognostic Factor in Localized Clear Cell Renal Cell Carcinoma

  • Kang X,
  • Shi H,
  • Wang D,
  • Xiao Z,
  • Tian J,
  • Bi X,
  • Jiang W,
  • Li C,
  • Ma J,
  • Zheng S,
  • Sun Y,
  • Shou J

Journal volume & issue
Vol. Volume 12
pp. 10023 – 10033

Abstract

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Xiangpeng Kang,1 Hongzhe Shi,1 Dong Wang,1 Zejun Xiao,1 Jun Tian,1 Xingang Bi,1 Weixing Jiang,1 Changling Li,1 Jianhui Ma,1 Shan Zheng,2 Yueping Sun,3 Jianzhong Shou1 1Department of Urinary Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People’s Republic of China; 2Department of Pathology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People’s Republic of China; 3Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, People’s Republic of ChinaCorrespondence: Yueping Sun Email [email protected] Shou Email [email protected]: This study aimed to construct a predictive model for recurrence and metastasis in patients with localized clear cell renal cell carcinoma (ccRCC) based on multiple preoperative blood indexes and oncological characteristics.Patients and Methods: Overall, 442 patients with localized ccRCC between 2013 and 2015 were included. Using least absolute shrinkage and selection operator (LASSO) Cox regression analysis, the top three risk factors from the peripheral blood indicators were screened to construct a risk score, and a prognostic model was established. Harrell’s concordance index (C-index) was applied to evaluate the predictive accuracy of the model for predicting disease-free survival (DFS) in ccRCC.Results: Out of 38 blood indexes, the top three predictors were fibrinogen (FIB), C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR). The FIB-CRP-NLR (FCN) score (hazard ratio [HR]: 1.86, 95% confidence interval [CI]: 1.21– 2.9, P = 0.005) was an independent prognostic factor in multivariate analysis. Furthermore, the FIB-CRP-NLR-T-Grade (FCNTG) risk model combining FCN score, T stage and Furhman grade achieved a higher prognostic accuracy (mean C-index, 0.728) than both the FCN score alone (mean C-index, 0.675) and the stage, size, grade, and necrosis (SSIGN) score (mean C-index, 0.686) in the validation cohort.Conclusion: The FCN score combining peripheral blood indicators of inflammation and coagulation is an independent prognostic marker of ccRCC. The FCNTG model, which systemically incorporates preoperative blood indexes to oncological characteristics, shows its advantages of convenience and high prediction efficiency.Keywords: clear cell renal cell carcinoma, prognosis, fibrinogen, C-reactive protein, neutrophil-lymphocyte ratio

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