Lymphopenia is a significant predictor of outcome in patients undergoing surgery for papillary renal cell carcinoma (PRCC), US researchers report.
The team says that the preoperative absolute lymphocyte count (ALC), a marker of systemic inflammatory response, has a similar prognostic power for the management of PRCC patients as it has for those with clear cell RCC.
“ALC may serve as a useful adjunct to already established PRCC prognosticators to help identify patients with clinically significant disease, who may benefit from enrollment into neoadjuvant or adjuvant clinical trials, and provide indications to tailor individual patient's postoperative surveillance schedules”, write Tahseen Al-Saleem, from Fox Chase Cancer Center–Temple Health System in Philadelphia, Pennsylvania, and co-workers.
This could also be true for patients with other types of cancer and lymphoma, they add in Urologic Oncology: Seminars and Original Investigations.
The ALC was measured at least 3 months before renal resection in 192 patients and the cohort was followed up for a median of 37.3 months.
Initial analysis of preoperative ALC as a continuous variable found the measurement to be significantly associated with Tumour Node Metastasis (TNM) stage and older age. And when assessed as a dichotomous variable, lymphopenia, which was defined as an ALC below 1300 cells/µL, was associated with increased TNM stage.
Moreover, multivariate analysis showed that lymphopaenia was a significant predictor of poor overall survival (hazard ratio = 2.28 vs ALC ≥1300 cells/µL) after adjusting for PRCC type, TNM stage, age, smoking and the Charlson comorbidity index.
There was also a strong trend towards poor cancer-specific survival for patients with lymphopaenia; this may not have reached statistical significance due to the relatively small number of cancer-related deaths, the researchers comment.
Nevertheless, the team concludes that larger, multicentre studies are required to validate the impact of lymphopenia in patients with PRCC.
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