Preoperative apolipoprotein B/A1 ratio is an independent prognostic factor in metastatic renal cell carcinoma

We aimed to explore the prognostic value of preoperative apolipoprotein B/apolipoprotein A1 (Apo B/A1) ratio in metastatic renal cell carcinoma (mRCC).

Between January 2006 and December 2016, patients with mRCC who underwent cytoreductive nephrectomy at the Chinese PLA General Hospital were enrolled. The clinical-pathological parameters were collected retrospectively, and the preoperative Apo B/A1 ratios of two different subgroups were compared. The cut-off value was determined with the receiver operating characteristic (ROC) curve. The value of preoperative Apo B/A1 ratio on oncological outcome was determined through Kaplan-Meier survival analysis and Cox regression analysis.

A total of 287 mRCC patients were enrolled in this study. The median postoperative follow-up time was 27.8 months (IQR, 12.5-58.6 months). The Apo B/A1 ratio was higher in the high Fuhrman grade (G3 and G4) group than that in the low Fuhrman grade (G1 and G2) group (P = 0.010). The area under the curve values of the ROC curves were 0.613 for progression-free survival (PFS) (P = 0.005) and 0.607 for overall survival (OS) (P = 0.004). The optimal cut-off values of Apo B/A1 ratio were 0.977 for PFS and 0.847 for OS. A high preoperative Apo B/A1 ratio (PFS ≥ 0.977; OS ≥ 0.847) was significantly associated with poor PFS (P < 0.0001) and OS (P = 0.0005). Cox regression analyses showed that the Apo B/A1 ratio is an independent prognostic factor for PFS (hazard ratio [HR] = 3.131; 95% confidence interval [CI] = 2.249-4.360; P < 0.001) and OS (HR = 2.173; 95% CI = 1.533-3.080; P < 0.001).

Preoperative Apo B/A1 ratio is an independent prognostic factor for PFS and OS in patients with mRCC. Preoperative Apo B/A1 ratio can be useful in improving current prognostic evaluation and treatment decision for patients with mRCC.