Prognostic Factors Related To The First-line Treatment Of Metastatic Renal Cell Carcinoma With VEGF-targeted Drugs: A Meta-analysis

Objective To widely explore the current prognostic models and individual factors in patients with metastatic renal cell carcinoma using VEGF-targeted agents as first-line therapy by meta-analysis.Methods A literature review of articles was conducted before March 31,2019 using the CNKI,Wanfang database,Pub Med,Web of Science and Embase Database.Articles providing survival outcome such as progression-free survival(PFS)or overall survival(OS)with hazard ratio(HR)and 95% confidence intervals(95% CI)were included.Stata 14.0 software was used for statistical analysis.Results A total of 28 articles were included in the meta-analysis including 3881 patients.The study analyzed the effects of International Metastatic Renal Cell Carcinoma Database Consortium(IMDC)model,Memorial Sloan-Kettering Cancer Center(MSKCC)model,age,gender,Eastern Cooperative Oncology Group(ECOG),Karnofsky Performance Status(KPS),tumor cell nuclear classification(Fuhrman grade),lymph nodes metastasis and neutrophil to lymphocyte ratio(NLR)on prognosis.1.In terms of combined HRs from univariate analysis for PFS,IMDC model(medium risk versus low risk,high risk versus low risk),MSKCC model(high risk versus low risk),ECOG(1versus 0),KPS(less than 80 versus more than or equal to 80)and NLR(more than 3 versus less than or equal to 3)were associated with prognosis.2.Regarding combined HRs from multivariate analysis for PFS,MSKCC model(medium risk versus low risk,high risk versus low risk),Fuhrman grade(3-4 versus 1-2),and NLR(more than 3 versus less than or equal to 3)were correlated to prognosis.3.About combined HRs from univariate analysis for OS,IMDC model(medium risk versus low risk,high risk versus low risk),MSKCC model(medium risk versus low risk,high risk versus low risk),ECOG(2 versus 0),KPS(less than 80 versus more than or equal to 80),Fuhrman grade(3-4 versus 1-2)and NLR(more than 3 versus less than or equal to 3)were related to prognosis.4.Considering combined HRs from multivariate analysis for OS,MSKCC model(high risk versus low risk),KPS(less than 80 versus more than or equal to 80)and NLR(more than 3 versus less than or equal to 3)had relationship with prognosis.Conclusion In patients with metastatic renal cell carcinoma using VEGF-targeted drugs as first-line therapy,IMDC model and MSKCC model have fine predictive value,and KPS,ECOG,Fuhrman grade and NLR also have relationship with prognosis.