Applying the prognostic value of intratumoral neutrophils to the Leibovich low-/intermediate-risk group showed a 5-year recurrence-free survival of 53% in patients with presence of intratumoral neutrophils compared with 87% in patients with absence of intratumoral neutrophils. The estimated concordance index was 0.74 using Alectinib molecular weight the Leibovich risk score and 0.80 when intratumoral neutrophils were added. Thus, patients with intratumoral neutrophils should have a closer follow-up. Intratumoral neutrophils may also serve as a new stratification factor for randomized trials [17]. In another study in patients with localized RCC, pre-treatment blood NLR has been demonstrated as an independent predictor of
recurrence [18]. Taken together, the prognostic relevance of neutrophils in localized and metastatic RCC is important and reveals a subgroup of patients with a very poor prognosis and only limited or no effect of cytokine or targeted therapy. Impaired prognostic impact has been noted for baseline blood neutrophils (range 4.5–7.5 × 109/L),
on-treatment week Veliparib 5 and week 8 blood neutrophils (range 2.19–4.57 × 109/L), and intra-tumoral presence of neutrophils both in localized and metastatic renal cell carcinoma. Further research to unravel the underlying biology is encouraged. The first report of neutrophils as an adverse prognostic factor for patients with metastatic melanoma (MMM) was published in 2005 by Schmidt et al. [19]. A total of 321 patients were treated as part of several phase II protocols with IL-2-based immunotherapy. A multivariate analysis identified elevated LDH, elevated baseline neutrophil counts (>ULN) and poor performance status as independent prognostic factors for poor survival. An elevated monocyte count could replace the elevated neutrophil count in the model. Patients were assigned to one of three
L-NAME HCl risk groups according to the cumulative risk defined as the sum of simplified risk scores of the three independent prognostic factors. High-risk patients achieved a median survival of 3.4 months and should probably not be offered IL-2-based immunotherapy [19]. The author validated this finding in an independent cohort of patients from the European Organization for the Research and Treatment of Cancer 18951-study treated with dacarbazine, cisplatin, and interferon alfa with or without interleukin-2 [20]. Two multivariate prognostic factor analyses were carried out in the model: one with leukocyte counts and one with neutrophil counts. A total of 363 patients were randomly assigned and baseline blood neutrophil and leukocyte counts were available from 316 and 350 patients, respectively. A high neutrophil count (>7.5 × 109/L) was an independent prognostic factor for short overall survival and a high leukocyte count (>10 × 109/L) was an independent prognostic factor of both short OS and short PFS.