Association between hemoglobin, calcium, and lactate dehydrogenase variability and mortality among metastatic renal cell carcinoma

Purpose There are no robust data on hemoglobin (Hb), lactate dehydrogenase (LDH), and calcium variability for overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) treated with vascular endothelial growth factor (VEGF)-targeted therapy. We aim to evaluate prognostic implicati...

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Bibliographic Details
Published in:International urology and nephrology 2014-06, Vol.46 (6), p.1081-1087
Main Authors: Cetin, Bulent, Afsar, Barıs, Deger, Serpil Muge, Gonul, Ipek Isık, Gumusay, Ozge, Ozet, Ahmet, Benekli, Mustafa, Coskun, Ugur, Buyukberber, Suleyman
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Antineoplastic Agents - therapeutic use
Calcium - blood
Carcinoma, Renal Cell - blood
Carcinoma, Renal Cell - drug therapy
Carcinoma, Renal Cell - secondary
Disease-Free Survival
Female
Hemoglobin A - metabolism
Humans
Indoles - therapeutic use
Kidney Neoplasms - blood
Kidney Neoplasms - drug therapy
Kidney Neoplasms - pathology
L-Lactate Dehydrogenase - blood
Male
Medicine
Medicine & Public Health
Middle Aged
Nephrology
Niacinamide - analogs & derivatives
Niacinamide - therapeutic use
Phenylurea Compounds - therapeutic use
Protein Kinase Inhibitors - therapeutic use
Pyrimidines - therapeutic use
Pyrroles - therapeutic use
Retrospective Studies
Risk Assessment
Sulfonamides - therapeutic use
Survival Rate
Urology
Urology - Original Paper
Vascular Endothelial Growth Factor A - antagonists & inhibitors
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Summary:Purpose There are no robust data on hemoglobin (Hb), lactate dehydrogenase (LDH), and calcium variability for overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) treated with vascular endothelial growth factor (VEGF)-targeted therapy. We aim to evaluate prognostic implications of Hb, LDH, and calcium variability and establish a novel risk stratification model in RCC patients receiving targeted therapies. Methods We retrospectively studied an unselected cohort of patients with mRCC, who were treated with tyrosine kinase inhibitors. We assessed LDH variability, Ca variability, and Hb variability with various methods using standard deviation and fluctuation across thresholds. Kaplan–Meier and log-rank analyses were employed on OS and multivariate Cox proportional hazard model analyzed clinical parameters for their prognostic relevance. Results A total of 59 patients intermediate-risk group according to the Memorial Sloan-Kettering Cancer Center with mRCC who had early progressed after first-line therapy with interferon-α were included in this retrospective single-center study conducted between February 2008 and December 2011. The mean Hb was 12.4 g/dl (min–max 9.1–15.2) throughout the study. Multivariable-adjusted Cox regression showed that patients in the consistently low-Hb group and patients in the low-amplitude and high-amplitude groups had a statistically significant increase in risk compared with patients who were consistently on target (HR 4.1; 95 % CI 1.3–12.9 and HR 2.9; 95 % CI 1.05–8.1 and HR 4.4; 95 % CI 1.7–11.1, respectively). On the other hand, the higher mean LDH (LDH more than 1 >upper limit of normal) was associated with OS. LDH variability and Ca variability were not associated with mortality. Conclusions In patients with mRCC treated with VEGF-targeted therapy, Hb variability and mean LDH level might be associated with OS. This should be investigated prospectively.
ISSN:0301-1623
1573-2584
DOI:10.1007/s11255-013-0613-x