Pacholczak-Madej Renata, Drobniak Artur, Grela-Wojewoda Aleksandra, Calik Jacek, Viegas Natalia Versuti, Tusień-Małecka Daria, Dobrzańska Jolanta, Roman Agnieszka, Bidas Anna, Szwiec Marek, Gawlik-Urban Angelika, Walocha Jerzy, Blecharz Paweł, Stokłosa Łukasz, Puskulluoglu Mirosława
Department of Chemotherapy, The District Hospital, Sucha Beskidzka, Poland.
Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, Poland.
Clin Exp Med. 2025 Jan 23;25(1):45. doi: 10.1007/s10238-024-01544-4.
Immune checkpoint inhibitors have improved the treatment of metastatic renal cell carcinoma (RCC), with the combination of nivolumab (NIVO) and ipilimumab (IPI) showing promising results. However, not all patients benefit from these therapies, emphasizing the need for reliable, easily assessable biomarkers. This multicenter study involved 116 advanced RCC patients treated with NIVO + IPI across nine oncology centers in Poland. Blood markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), eosinophils, and monocytes were assessed at baseline, after three months, and before disease progression (PD). The prognostic significance of these parameters was analyzed using linear regression, Kaplan-Meier survival analysis, and Cox regression models. After a median follow-up of 11.8 months, the progression-free survival (PFS) was 12.8 months (95% confidence interval [CI] 5.7-28.1), while the overall survival (OS) was 27.3 months (95% CI 16-not reached). Patients with an NLR increase of ≥ 25% had a PFS of 8.2 (3.1-24.7) months compared to 17.5 (8.6-28.1) months in those with a rise in < 25% (p = 0.015). Similarly, a ≥ 25% increase in PLR was linked to a PFS of 6.8 (2.8-8.3) months compared to 17.4 (8.4-28.1) months (p < 0.001). Multivariate analysis confirmed PLR as an independent predictor of PFS (HR 2.9, 95% CI 1.5-5.6, p = 0.001), while elevated eosinophil levels were associated with a reduced risk of death (HR 0.2, 95% CI 0.04-0.9, p = 0.05). No other analysis was statistically significant. NLR, PLR, and eosinophil levels may serve as valuable biomarkers for predicting treatment response in RCC patients receiving NIVO + IPI.
免疫检查点抑制剂改善了转移性肾细胞癌（RCC）的治疗，纳武单抗（NIVO）和伊匹单抗（IPI）联合使用显示出了有前景的结果。然而，并非所有患者都能从这些疗法中获益，这凸显了对可靠、易于评估的生物标志物的需求。这项多中心研究纳入了波兰九个肿瘤中心的116例接受NIVO+IPI治疗的晚期RCC患者。在基线、三个月后以及疾病进展（PD）前评估血液标志物，如中性粒细胞与淋巴细胞比率（NLR）、血小板与淋巴细胞比率（PLR）、淋巴细胞与单核细胞比率（LMR）、嗜酸性粒细胞和单核细胞。使用线性回归、Kaplan-Meier生存分析和Cox回归模型分析这些参数的预后意义。中位随访11.8个月后，无进展生存期（PFS）为12.8个月（95%置信区间[CI]5.7-28.1），总生存期（OS）为27.3个月（95%CI 16-未达到）。NLR升高≥25%的患者PFS为8.2（3.1-24.7）个月，而升高<25%的患者PFS为17.5（8.6-28.1）个月（p=0.015）。同样，PLR升高≥25%与PFS为6.8（2.8-8.3）个月相关，而升高<25%的患者PFS为17.4（8.4-28.1）个月（p<0.001）。多变量分析证实PLR是PFS的独立预测因子（HR 2.9，95%CI 1.5-5.6，p=0.001），而嗜酸性粒细胞水平升高与死亡风险降低相关（HR 0.2，95%CI 0.04-0.9，p=0.05）。其他分析均无统计学意义。NLR、PLR和嗜酸性粒细胞水平可能是预测接受NIVO+IPI治疗的RCC患者治疗反应的有价值生物标志物。
