Kidney cancer patients face high recurrence risk for tumour containing neutrophils

Tuesday, 30 September 2008-  A Danish study showed that patients who have a nephrectomy for localized kidney cancer may have a higher recurrence risk  if the tumour contains neutrophils.

According to a retrospective study of 123 patients with localized renal cell carcinoma, the presence of intratumoural neutrophils nearly tripled the risk of poor outcomes. Researcher Hanne Krogh Jensen, M.D., of Aarhus University Hospital in Aarhus, Denmark, reported her findings at the Kidney Cancer Association's (KCA) international symposium.

The researchers calculated the following hazard ratios for poor outcome: Overall survival: 2.9 (95% CI 1.8 to 4.8) ; Cancer-specific mortality: 3.3 (95% CI 1.8 to 5.9); LINE THREE

The recurrence-free survival rate after 10 years in patients without intratumoural neutrophils was nearly 70%, compared with 25% in those whose tumours were infiltrated with the immune cells (P<0.0001).

Among 79 patients with low to intermediate risk according to so-called Leibovich criteria -- based on sign, stage, grade, and necrosis -- the 10-year recurrence-free survival rate was 73% in the absence of intratumoural neutrophils, compared with 36% when neutrophils were present (P<0.0001). The study also confirmed that conventional risk factors such as blood hemoglobin, tumor classification, nodal involvement, and performance status were also significant predictors of outcome.

Jensen said the study was prompted by earlier research at Aarhus that identified intratumoural neutrophils and several other inflammatory markers as possible risk factors for reduced survival in patients with metastatic kidney cancer.

Researchers have long suspected that immune cells are connected to tumour growth and aggressiveness, but most studies have focused on T cells as potential prognostic factors. The researchers studied clinical samples taken from 123 consecutive patients who had undergone nephrectomy for localized cancer from 1992 to 2001 at the Aarhus hospital and for whom follow-up data were available.

Before intratumoural neutrophil counts can be used as a clinical prognostic test, Jensen said the association needs to be validated in larger, prospective studies.

David Nanus, M.D., a urologist and renal oncologist at Weill Cornell Medical College in New York, called the research interesting but too early to have immediate clinical relevance.

Ref: Kidney Cancer Association Meeting, Jensen H, et al "The presence of intra-tumoral neutrophils is an independent risk factor in localized renal cell carcinoma" KCA 2008; Abstract 13.

Filed by: JV/MedPage Today

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