The Prognostic Role of Baseline and Early Dynamics of Peripheral Blood Cell Ratios in Metastatic Renal Cell Carcinoma Patients Treated With Nivolumab

Background/Aim: Immune checkpoint inhibitors (ICI), including nivolumab, have become the cornerstone of systemic treatment in metastatic renal cell carcinoma (mRCC). Blood-derived biomarkers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) have emerged as important indicators of systemic inflammatory and immune status. The aim of this study was to evaluate the prognostic and predictive value of NLR, PLR, and LMR at baseline and their early dynamics during nivolumab monotherapy in mRCC patients. Patients and Methods: The associations of baseline NLR, PLR, LMR and their changes (Δ) after one month of nivolumab therapy with patient outcomes including progression-free survival (PFS), overall survival (OS) and objective response rate (ORR) were retrospectively analyzed. Results: In total, 310 patients were included. Baseline NLR ≥4 (PFS: HR=2.136, p<0.001; OS: HR=2.442, p<0.001), PLR ≥310 (PFS: HR=2.383, p<0.001; HR=3.604, p<0.001), and LMR <1.5 (PFS: HR=1.802, p=0.002; OS: HR=2.273, p<0.001) were independent factors for inferior PFS and OS. Regarding early changes, ΔNLR ≥2 (PFS: HR=3.019, p<0.001; OS: HR=3.095, p<0.001) and ΔPLR ≥20 (PFS: HR=1.436, p=0.024; OS: HR=1.719, p=0.006) were independent factors for inferior PFS and OS, while ΔLMR <0 was independent factor for inferior PFS (HR=1.458, p=0.030). Lower ORR was associated with baseline NLR ≥4 (p=0.020), ΔNLR ≥2 (p=0.010), and ΔPLR ≥20 (p=0.019). Conclusion: The results of the present study suggest a prognostic role for baseline NLR, PLR and LMR. In addition, an early change in NLR and PLR is associated with patient outcome and represents a candidate surrogate biomarker for monitoring the immunotherapy response.