World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Original Article

Volume 10, Number 2, April 2019, pages 101-111

Predictors of Progression-Free Survival and Overall Survival in Metastatic Non-Clear Cell Renal Cell Carcinoma: A Single-Center Experience

Figure 1. The predictive ability of ROC curve to determine the cut-off point for (a) PLR, (b) LMR, (c) SII index and (d) CAR in relation to disease progression. ROC: receive operating characteristic; PLR: platelet to lymphocyte ratio; LMR: lymphocyte to monocyte ratio; SII: systemic immune inflammation; CAR: C-reactive protein/albumin ratio.

Figure 2. Kaplan-Meier plots illustrating PFS according to the (a) PLR, (b) LMR, (c) SII index and (d) CAR, respectively. PFS: progression-free survival; PLR: platelet to lymphocyte ratio; LMR: lymphocyte to monocyte ratio; SII: systemic immune inflammation; CAR: C-reactive protein/albumin ratio.

Figure 3. Kaplan-Meier plots illustrating OS according to the (a) PLR, (b) LMR, (c) SII index and (d) CAR, respectively. OS: overall survival; PLR: platelet to lymphocyte ratio; LMR: lymphocyte to monocyte ratio; SII: systemic immune inflammation; CAR: C-reactive protein/albumin ratio.

**Table 1.** Epidemiological and Clinicopathological Data in the Progression and Non-Progression Group
Characteristics	Progression, N (%)	Non-progression, N (%)	Chi-square coefficient	P value	Pearson’s R coefficient	P value
The percentage value depicted denotes the value within the respective progression or non-progression groups. FG: Fuhrman nuclear grade; TN: tumor necrosis; LN: lymph node; MI: microscopic invasion; PLR: platelet to lymphocyte ratio; LMR: lymphocyte to monocyte ratio; SII: systemic immune inflammation; CAR: C-reactive protein/albumin ratio; SST: scan to surgery time; MSKCC: Memorial Sloan Kettering Cancer Center.
Median age (years)	62 ± 3.14	54 ± 4.52	N/A
Histology			27.488	0.0001	0.045	0.810
PAP	9 (47.4)	0
CHR	1 (5.3)	5 (41.7)
COLL	0	7 (58.3)
UNC	9 (47.4)	0
Sex			0.793	0.373	0.160	0.390
Male	14 (73.7)	7 (58.3)
Female	5 (26.3)	5 (41.7)
Site			0.001	0.981	0.004	0.180
Rt	8 (42.1)	5 (41.7)
Lt	11 (57.9)	7 (58.3)
Tumor stage			0.327	0.567	0.103	0.582
T1, T2	6 (31.6)	5 (41.7)
T3, T4	13 (68.4)	7 (58.3)
FG			8.76	0.042	3.071	0.007
FG1, FG2	10 (52.6)	5 (41.7)
FG3, FG4	9 (47.4)	7 (58.3)
TN			7.20	0.046	0.026	0.891
Yes	10 (52.6)	6 (50)
No	9 (47.4)	6 (50)
(p) LN status			6.595	0.044	0.639	0.032
Yes	9 (47.4)	4 (33.3)
No	10 (52.6)	8 (66.7)
MI			3.951	0.047	0.357	0.049
Yes	13 (68.4)	5 (41.7)
No	6 (31.6)	7 (58.3)
PLR			6.304	0.020	0.451	0.011
> 171	18 (94.7)	1 (8.3)
≤ 171	1 (5.3)	11 (91.7)
LMR			6.450	0.011	0.456	0.010
< 2.61	15 (78.9)	4 (33.3)
≥ 2.61	4 (21.1)	8 (66.7)
SII index			17.098	0.0001	0.743	0.0001
> 883	16 (84.2)	1 (8.3)
≤ 883	3 (15.8)	11 (91.7)
CAR			4.213	0.043	0.522	0.037
> 0.11	11 (57.9)	3 (25)
≤ 0.11	8 (42.1)	9 (75)
SST (median)			19.774	0.0001	16.734	0.0001
> 3.9	17 (89.5)	0
≤ 3.9	2 (10.5)	12 (100)
MSKCC groups			13.65	0.012	11.5	0.034
Intermediate	7 (36.8)	8 (72.7)
Poor	12 (63.2)	4 (33.3)

Table 1. Epidemiological and Clinicopathological Data in the Progression and Non-Progression Group

Characteristics

Progression, N (%)

Non-progression, N (%)

Chi-square coefficient

P value

Pearson’s R coefficient

P value

The percentage value depicted denotes the value within the respective progression or non-progression groups. FG: Fuhrman nuclear grade; TN: tumor necrosis; LN: lymph node; MI: microscopic invasion; PLR: platelet to lymphocyte ratio; LMR: lymphocyte to monocyte ratio; SII: systemic immune inflammation; CAR: C-reactive protein/albumin ratio; SST: scan to surgery time; MSKCC: Memorial Sloan Kettering Cancer Center.

Median age (years)

62 ± 3.14

54 ± 4.52

N/A

Histology

27.488

0.0001

0.045

0.810

PAP

9 (47.4)

CHR

1 (5.3)

5 (41.7)

COLL

7 (58.3)

UNC

9 (47.4)

Sex

0.793

0.373

0.160

0.390

Male

14 (73.7)

7 (58.3)

Female

5 (26.3)

5 (41.7)

Site

0.001

0.981

0.004

0.180

8 (42.1)

5 (41.7)

11 (57.9)

7 (58.3)

Tumor stage

0.327

0.567

0.103

0.582

T1, T2

6 (31.6)

5 (41.7)

T3, T4

13 (68.4)

7 (58.3)

8.76

0.042

3.071

0.007

FG1, FG2

10 (52.6)

5 (41.7)

FG3, FG4

9 (47.4)

7 (58.3)

7.20

0.046

0.026

0.891

Yes

10 (52.6)

6 (50)

9 (47.4)

6 (50)

(p) LN status

6.595

0.044

0.639

0.032

Yes

9 (47.4)

4 (33.3)

10 (52.6)

8 (66.7)

3.951

0.047

0.357

0.049

Yes

13 (68.4)

5 (41.7)

6 (31.6)

7 (58.3)

PLR

6.304

0.020

0.451

0.011

> 171

18 (94.7)

1 (8.3)

≤ 171

1 (5.3)

11 (91.7)

LMR

6.450

0.011

0.456

0.010

< 2.61

15 (78.9)

4 (33.3)

≥ 2.61

4 (21.1)

8 (66.7)

SII index

17.098

0.0001

0.743

0.0001

> 883

16 (84.2)

1 (8.3)

≤ 883

3 (15.8)

11 (91.7)

CAR

4.213

0.043

0.522

0.037

> 0.11

11 (57.9)

3 (25)

≤ 0.11

8 (42.1)

9 (75)

SST (median)

19.774

0.0001

16.734

0.0001

> 3.9

17 (89.5)

≤ 3.9

2 (10.5)

12 (100)

MSKCC groups

13.65

0.012

11.5

0.034

Intermediate

7 (36.8)

8 (72.7)

Poor

12 (63.2)

4 (33.3)

**Table 2.** Multivariate Analysis for Variable Considered for PFS and OS
Characteristics	PFS	OS
PFS: progression-free survival; OS: overall survival; FG: Fuhrman nuclear grade; TN: tumor necrosis; LN: lymph node; MI: microscopic invasion; PLR: platelet to lymphocyte ratio; LMR: lymphocyte to monocyte ratio; SII: systemic immune inflammation; CAR: C-reactive protein/albumin ratio; SST: scan to surgery time; CI: confidence interval; HR: hazard ratio.
Age (years)	0.569 - 1.073	0.781	0.127	0.247 - 1.316	0.570	0.188
T stage	0.023 - 5.831	1.150	0.944	0.029 - 24.822	9.158	0.558
FG	0.847 - 28.416	15.51	0.065	0.157 - 22.150	15.922	0.151
TN	9.671 - 25.349	15.65	0.005	0.033 - 5.789	4.366	0.303
(p) LN status	4.811 - 24.781	14.67	0.012	0.414 - 14.183	6.317	0.251
MI	0.435 - 8.612	6.120	0.179	0.060 - 8.554	6.175	0.891
PLR	1.102 - 1.460	1.269	0.001	0.865 - 1.933	1.293	0.045
LMR	0.253 - 8.368	1.456	0.001	0.713 - 16.101	8.667	0.001
SII index	1.005 - 1.040	1.023	0.010	0.992 - 1.043	1.017	0.183
CAR	0.564 - 6.578	4.445	0.001	0.076 - 1.763	1.002	0.554
SST	0.006 - 0.311	0.041	0.002	0.342 - 15.560	11.024	0.259

Table 2. Multivariate Analysis for Variable Considered for PFS and OS

Characteristics

PFS

95% CI

P value

95% CI

P value

PFS: progression-free survival; OS: overall survival; FG: Fuhrman nuclear grade; TN: tumor necrosis; LN: lymph node; MI: microscopic invasion; PLR: platelet to lymphocyte ratio; LMR: lymphocyte to monocyte ratio; SII: systemic immune inflammation; CAR: C-reactive protein/albumin ratio; SST: scan to surgery time; CI: confidence interval; HR: hazard ratio.

Age (years)

0.569 - 1.073

0.781

0.127

0.247 - 1.316

0.570

0.188

T stage

0.023 - 5.831

1.150

0.944

0.029 - 24.822

9.158

0.558

0.847 - 28.416

15.51

0.065

0.157 - 22.150

15.922

0.151

9.671 - 25.349

15.65

0.005

0.033 - 5.789

4.366

0.303

(p) LN status

4.811 - 24.781

14.67

0.012

0.414 - 14.183

6.317

0.251

0.435 - 8.612

6.120

0.179

0.060 - 8.554

6.175

0.891

PLR

1.102 - 1.460

1.269

0.001

0.865 - 1.933

1.293

0.045

LMR

0.253 - 8.368

1.456

0.001

0.713 - 16.101

8.667

0.001

SII index

1.005 - 1.040

1.023

0.010

0.992 - 1.043

1.017

0.183

CAR

0.564 - 6.578

4.445

0.001

0.076 - 1.763

1.002

0.554

SST

0.006 - 0.311

0.041

0.002

0.342 - 15.560

11.024

0.259

**Table 3.** Estimated and Actuarial Survival Data for OS Based on Kaplan-Meier Survival Plots
Variables	Actuarial survival (%)	Estimated mean OS (95% CI) (months)	SE	Log rank (Mantel Cox) coefficient	P value
OS: overall survival; PLR: platelet to lymphocyte ratio; LMR: lymphocyte to monocyte ratio; SII: systemic immune inflammation; CAR: C-reactive protein/albumin ratio; CI: confidence interval; SE: standard error.
PLR	66	49.5	39.6	12.6 (10.2 - 14.9)	2.47	10.83	0.001
LMR	68.2	53	45.5	13.5 (10.9 - 15.9)	5.13	4.44	0.035
SII index	77.9	60.6	50.5	13.9 (11.5 - 16.2)	4.78	3.43	0.064
CAR	57.1	52.3	47.6	13.5 (10.3 - 16.6)	6.51	1.45	0.229

Table 3. Estimated and Actuarial Survival Data for OS Based on Kaplan-Meier Survival Plots

Variables

Actuarial survival (%)

Estimated mean OS (95% CI) (months)

Log rank (Mantel Cox) coefficient

P value

9 months

12 months

14 months

OS: overall survival; PLR: platelet to lymphocyte ratio; LMR: lymphocyte to monocyte ratio; SII: systemic immune inflammation; CAR: C-reactive protein/albumin ratio; CI: confidence interval; SE: standard error.

PLR

49.5

39.6

12.6 (10.2 - 14.9)

2.47

10.83

0.001

LMR

68.2

45.5

13.5 (10.9 - 15.9)

5.13

4.44

0.035

SII index

77.9

60.6

50.5

13.9 (11.5 - 16.2)

4.78

3.43

0.064

CAR

57.1

52.3

47.6

13.5 (10.3 - 16.6)

6.51

1.45

0.229

**Table 4.** Estimated and Actuarial Survival Data for PFS Based on Kaplan-Meier Survival Plots
Variables	Actuarial survival (%)	Estimated mean PFS (95% CI) (months)	SE	Log rank (Mantel Cox) coefficient	P value
PFS: progression-free survival; PLR: platelet to lymphocyte ratio; LMR: lymphocyte to monocyte ratio; SII: systemic immune inflammation; CAR: C-reactive protein/albumin ratio; CI: confidence interval; SE: standard error.
PLR	39.3	16.8	5.6	7.8 (6.1 - 9.4)	2.93	22.10	0.0001
LMR	35.1	29.2	17.5	9 (6.8 - 11.3)	4.57	5.79	0.016
SII index	35.3	23.5	5.9	8.5 (6.8 - 10.3)	3.63	10.73	0.001
CAR	39.3	23.4	15.6	8.2 (5.8 - 10.6)	4.91	4.74	0.029

Table 4. Estimated and Actuarial Survival Data for PFS Based on Kaplan-Meier Survival Plots

Variables

Actuarial survival (%)

Estimated mean PFS (95% CI) (months)

Log rank (Mantel Cox) coefficient

P value

9 months

12 months

14 months

PFS: progression-free survival; PLR: platelet to lymphocyte ratio; LMR: lymphocyte to monocyte ratio; SII: systemic immune inflammation; CAR: C-reactive protein/albumin ratio; CI: confidence interval; SE: standard error.

PLR

39.3

16.8

5.6

7.8 (6.1 - 9.4)

2.93

22.10

0.0001

LMR

35.1

29.2

17.5

9 (6.8 - 11.3)

4.57

5.79

0.016

SII index

35.3

23.5

5.9

8.5 (6.8 - 10.3)

3.63

10.73

0.001

CAR

39.3

23.4

15.6

8.2 (5.8 - 10.6)

4.91

4.74

0.029