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

Abstract 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.