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Background <p>This study investigated whether neutrophil-to-lymphocyte ratio (NLR) kinetics, including changes within the first week after the initiation of first-line combination immunotherapy, are associated with overall survival (OS) in patients with advanced renal cell carcinoma (aRCC).</p> Methods <p>Consecutive patients with aRCC treated with first-line immune checkpoint inhibitor combination therapy at 12 Japanese institutions were included in this retrospective study. The NLR was assessed at baseline (BL), within 7 days (D7), and 1 month (M1) after treatment initiation. Patients were classified into three groups according to NLR at BL and at D7 as follows: BL NLR low (&lt; 3), NLR high-low (BL NLR ≥ 3 and D7 NLR &lt; 3), and NLR high-high (BL NLR ≥ 3 and D7 NLR ≥ 3) groups.</p> Results <p>In total, 198 patients were included in the study, with a median follow-up of 18.0 months. The median NLR changed during follow-up at BL, D7, and M1 (BL, 3.28; D7, 3.23; M1, 2.74). OS stratified by NLR at each time point was significant at BL and D7, but not at M1. Among patients with BL NLR ≥ 3 (55%, <i>n</i> = 109), 26 patients (24%) had D7 NLR &lt; 3. The 2&#xa0;year OS rates were 83.7, 85.5, and 66.0% for patients in the low-, high-low-, and high-high groups, respectively. Multivariate analysis revealed that high NLR was an independent risk factor associated with worse OS.</p> Conclusions <p>The combination of BL NLR and D7 NLR identified high-risk patients with aRCC treated with first-line immune checkpoint inhibitor therapy.</p>

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Combination of baseline and first-week neutrophil-to-lymphocyte ratio predicts overall survival in advanced renal cell carcinoma treated with first-line combination immunotherapy

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  • 发表日期：

    2026年7月11日

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  • Takeshi Sasaki,
  • Shinichiro Higashi,
  • Kouhei Nishikawa,
  • Koji Iinuma,
  • Keita Nakane,
  • Tomoki Taniguchi,
  • Yuta Sano,
  • Aika Matsuyama,
  • Kaori Ozawa,
  • Kosuke Tochigi,
  • Masataka Tamura,
  • Yasuaki Kubota,
  • Shusuke Akamatsu,
  • Takuya Koie,
  • Takahiro Inoue

摘要

Background

This study investigated whether neutrophil-to-lymphocyte ratio (NLR) kinetics, including changes within the first week after the initiation of first-line combination immunotherapy, are associated with overall survival (OS) in patients with advanced renal cell carcinoma (aRCC).

Methods

Consecutive patients with aRCC treated with first-line immune checkpoint inhibitor combination therapy at 12 Japanese institutions were included in this retrospective study. The NLR was assessed at baseline (BL), within 7 days (D7), and 1 month (M1) after treatment initiation. Patients were classified into three groups according to NLR at BL and at D7 as follows: BL NLR low (< 3), NLR high-low (BL NLR ≥ 3 and D7 NLR < 3), and NLR high-high (BL NLR ≥ 3 and D7 NLR ≥ 3) groups.

Results

In total, 198 patients were included in the study, with a median follow-up of 18.0 months. The median NLR changed during follow-up at BL, D7, and M1 (BL, 3.28; D7, 3.23; M1, 2.74). OS stratified by NLR at each time point was significant at BL and D7, but not at M1. Among patients with BL NLR ≥ 3 (55%, n = 109), 26 patients (24%) had D7 NLR < 3. The 2 year OS rates were 83.7, 85.5, and 66.0% for patients in the low-, high-low-, and high-high groups, respectively. Multivariate analysis revealed that high NLR was an independent risk factor associated with worse OS.

Conclusions

The combination of BL NLR and D7 NLR identified high-risk patients with aRCC treated with first-line immune checkpoint inhibitor therapy.