The lymphocyte-to-monocyte ratio as a significant inflammatory marker associated with survival of patients with metastatic renal cell carcinoma treated using nivolumab plus ipilimumab therapy

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发表日期：

2024年5月26日

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Kazuyuki Numakura,
Yuya Sekine,
Takahiro Osawa,
Sei Naito,
Ojiro Tokairin,
Yumina Muto,
Ryuta Sobu,
Mizuki Kobayashi,
Hajime Sasagawa,
Ryohei Yamamoto,
Taketoshi Nara,
Mitsuru Saito,
Shintaro Narita,
Hideo Akashi,
Norihiko Tsuchiya,
Nobuo Shinohara,
Tomonori Habuchi

摘要

Background

Nivolumab plus ipilimumab (NIVO + IPI) is the first-line treatment for patients with metastatic renal cell carcinoma (mRCC). While approximately 40% of patients treated with NIVO + IPI achieve a durable response, 20% develop primary resistance with severe consequences. Therefore, there is a clinical need for criteria to select patients suitable for NIVO + IPI therapy to optimize its therapeutic efficacy. Accordingly, our aim was to evaluate the association between candidate biomarkers measured before treatment initiation and survival.

Methods

This was a multi-institutional, retrospective, cohort study of 183 patients with mRCC treated with systematic therapies between August 2015 and July 2023. Of these, 112 received NIVO + IPI as first-line therapy: mean age, 68 years; men, 83.0% (n = 93), and clear cell histology, 80.4% (n = 90). Univariable and multivariable analyses were used to evaluate associations between biomarkers and survival.

Results

On univariate analysis, high C-reactive protein and systemic index, a high neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio, and a low lymphocyte-to-monocyte ratio (LMR) were associated with shorter overall survival (OS). On multivariable analysis, a LMR ≤ 3 was retained as an independent factor associated to shorter OS with the highest accuracy (C-index, 0.656; hazard ratio, 7.042; 95% confidence interval, 2.0–25.0; p = 0.002).

Conclusion

A low LMR may identify patients who would be candidate for NIVO + IPI therapy for mRCC.