Immune checkpoint inhibitors (ICI), including nivolumab, have become the cornerstone of systemic treatment in metastatic renal cell carcinoma (mRCC). Blood-derived biomarkers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) have emerged as important indicators of systemic inflammatory and immune status. The aim of this study was to evaluate the prognostic and predictive value of NLR, PLR, and LMR at baseline and their early dynamics during nivolumab monotherapy in mRCC patients.
The associations of baseline NLR, PLR, LMR and their changes (Δ) after one month of nivolumab therapy with patient outcomes including progression-free survival (PFS), overall survival (OS) and objective response rate (ORR) were retrospectively analyzed.
In total, 310 patients were included. Baseline NLR ≥4 (PFS: HR=2.136, p<0.001; OS: HR=2.442, p<0.001), PLR ≥310 (PFS: HR=2.383, p<0.001; HR=3.604, p<0.001), and LMR <1.5 (PFS: HR=1.802, p=0.002; OS: HR=2.273, p<0.001) were independent factors for inferior PFS and OS. Regarding early changes, ΔNLR ≥2 (PFS: HR=3.019, p<0.001; OS: HR=3.095, p<0.001) and ΔPLR ≥20 (PFS: HR=1.436, p=0.024; OS: HR=1.719, p=0.006) were independent factors for inferior PFS and OS, while ΔLMR <0 was independent factor for inferior PFS (HR=1.458, p=0.030). Lower ORR was associated with baseline NLR ≥4 (p=0.020), ΔNLR ≥2 (p=0.010), and ΔPLR ≥20 (p=0.019).
The results of the present study suggest a prognostic role for baseline NLR, PLR and LMR. In addition, an early change in NLR and PLR is associated with patient outcome and represents a candidate surrogate biomarker for monitoring the immunotherapy response.
In vivo (Athens, Greece). 2026 Jan [Epub]
Ondrej Fiala, Michaela Tkadlecova, Jindrich Kopecky, Petr Hosek, Hana Studentova, Michal Vocka, Martin Mateju, Radka Lohynska, Dominika Sikova, Petr Stransky, Radek Kucera, Anezka Zemankova, Martina Spisarova, Peter Priester, Jan Kouril, Tomas Buchler, Lucie Grmelova, Bohuslav Melichar, Alexandr Poprach
Department of Oncology and Radiotherapeutics, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic; ., Department of Oncology and Radiotherapeutics, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic., Department of Oncology, University Hospital in Hradec Králové, Králové, Czech Republic., Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic., Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc, Czech Republic., Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic., Department of Oncology, First Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic., Department of Urology, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic., Department of Pharmacology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic., Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic., Department of Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic., Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic.