Renal cell carcinoma (RCC) is a common and aggressive urological malignancy with a complex tumor microenvironment that may influence systemic inflammation. This review aimed to comprehensively explore the association between the systemic inflammatory response index (SIRI) and prognosis in patients with renal cell carcinoma (RCC) through a systematic review and meta-analysis.
Following the PRISMA guidelines, we systematically searched PubMed, Embase, Web of Science, and the Cochrane Library up to September 2025. Studies investigating the predictive value of SIRI [SIRI = (neutrophil count × monocyte count)/lymphocyte count] for overall survival (OS), cancer-specific survival (CSS), or progression-free survival (PFS) in patients with localized and advanced RCC were included. Two researchers independently performed article screening, data extraction, and quality assessment. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were pooled using a random-effects model with Review Manager 5.4.1 software. The I2 metric was applied to assess heterogeneity, and Egger's test, along with the trim-and-fill method, was used to detect and adjust for publication bias.
A total of 10 studies involving 5,314 patients were included. Meta-analysisresults showed that a higher SIRI was significantly associated with shorter OS (HR =2.47, 95% CI: 1.85-3.29, P<0.00001), although there was high heterogeneity (I2=76%). Furthermore, a higher SIRI was associated with shorter CSS (HR =3.60, 95% CI: 1.40-9.26, P=0.008) and shorter PFS (HR =1.21, 95% CI: 1.11-1.33, P<0.0001). Sensitivity analyses showed that the results for OS and PFS were robust, but the results for CSS became non-significant after excluding specific studies. The analysis of OS revealed publication bias, but the association remained significant after adjustment for trimming and filling.
This study demonstrates that a higher SIRI is a potential predictor of adverse prognosis (including OS, CSS, and PFS) in patients with RCC. As an easily accessible inflammatory marker, SIRI may have important clinical value in the risk stratification of RCC, but the findings still need to be further verified by prospective studies.
Translational andrology and urology. 2026 Mar 27 [Epub]
Qiang Dai, Xiaodong Tan, Peng Huang, Jin Zhang, Hongxue Zhu
Department of Urology, The Third People's Hospital of Xindu District, Chengdu, China.