Reliable prognostic markers for immune checkpoint inhibitor (ICI) response in metastatic renal cell carcinoma (mRCC) remain limited. We examined the impact of splenic volume change after ICI initiation on progression-free survival (PFS) and overall survival (OS) in patients with mRCC.
We retrospectively reviewed the Emory Kidney Cancer database for patients with mRCC who underwent any first-line ICI treatment between 2015-2023 and had available abdominal imaging 30 days before and 60-120 days after ICI initiation. Using the formula 30 + (0.58 x width x length x thickness), baseline and follow-up splenic volume were calculated as a percentage difference and grouped into ≥ 10% increase and < 10% increase. Kaplan-Meier curves and multivariable Cox hazards regression models assessed differences in OS and PFS between groups.
A total of 109 patients met inclusion criteria. Median follow up time was 25.2 months (IQR 11.2-41.5), during which there were 47 mortality events. Patients with a splenic volume increase ≥ 10% at a median 2.8 months after ICI initiation had worse 2-year PFS (28.5% vs 50.4%, p = 0.022), but not OS (69.4% vs 77.8%, p = 0.853) compared to patients with a < 10% increase in splenic volume. On multivariable analysis, a splenic volume increase ≥ 10% was independently associated with worse PFS (2.33 [95% CI 1.37--4.17], p = 0.002).
In patients with mRCC, a splenic volume increase ≥ 10% at a median of 2.8 months following ICI initiation is independently associated with worse survival compared to an < 10% increase.
The oncologist. 2026 Jan 06 [Epub ahead of print]
Gregory Palmateer, Ahmet Yildirim, Taylor Goodstein, Dattatraya Patil, Samay Patel, Shreyas Joshi, Vikram Narayan, Jacqueline T Brown, Bassel Nazha, Shahid S Ahmed, Jordan Ciuro, Bradley C Carthon, Omer Kucuk, Haydn Kissick, Kenneth Ogan, Mehmet A Bilen, Viraj A Master
Department of Urology, Emory University School of Medicine, Atlanta, GA., Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA.