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Impact of Immune Parameters on Long-Term Survival in Metastatic Renal Cell Carcinoma

Frede Donskov, Hans von der Maase

From the Department of Oncology, Aarhus University Hospital, Aarhus, Denmark

Address reprint requests to Frede Donskov, MD, Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark; e-mail: fd{at}microbiology.au.dk

PURPOSE: The purpose of this study was to evaluate the impact of immunologic prognostic factors in combination with established clinical prognostic factors in patients with metastatic renal cell carcinoma (mRCC).

PATIENTS AND METHODS: A total of 120 consecutive patients with mRCC received interleukin-2 (IL-2) -based immunotherapy. Baseline tumor biopsies were available from 85 of these patients. Potential prognostic factors were analyzed by univariate and multivariate analyses.

RESULTS: Multivariate analysis (N = 120) identified high lactate dehydrogenase, lymph node metastases, low hemoglobin, low Karnofsky performance status, and bone metastases as independent poor prognostic clinical factors. The impact of these clinical factors has been demonstrated by others. Multivariate analysis (n = 85) also identified a high blood neutrophil count (> 6.0 x 10⁹/L; hazard ratio, 2.0; P = .015), the presence of intratumoral neutrophils (> 0 cells/mm² tumor tissue; hazard ratio, 2.3; P = .001), and low intratumoral CD57⁺ natural killer cell count (< 50 cells/mm² tumor tissue; hazard ratio, 2.1; P = .01) as independent poor prognostic immunologic factors. These three independent immunologic parameters had significant discriminatory power as supplemental risk factors in prognostic models based on the clinical risk factors, identifying subgroups within the favorable clinical group with estimated 5-year survival rates of 60%, 25%, and 0%, respectively. These findings were apparent in both our own prognostic model and in an extended Memorial Sloan-Kettering Cancer Center (New York, NY) prognostic model.

CONCLUSION: This study points on five clinical and three supplemental immunologic independent prognostic factors of survival in patients with mRCC receiving IL-2.

Supported by the Danish Research Council, the foundations of Max and Inger Woerzner, Gerda and Aage Haench, Kristian Kjaer, Beckett, Preben and Anna Simonsen, Agnes Niebuhr Andersson, Johannes Fogh-Nielsen, Agnes and Poul Friis, Erland Richard Frederiksen, Hans and Nora Burchard, and Aarhus Radium Center Research Foundation.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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