The Impact of Systemic Inflammation and Nutritional Indicators on Progression-Free Survival in Patients with Metastatic Clear Cell Renal Carcinoma Receiving First-Line Tyrosine Kinase Inhibitor Therapy

Authors : Galip Can Uyar, Güner Akgüner, Kadriye Başkurt, Enes Yeşilbaş, Seher Kaya, Gökşen İnanç İmamoğlu

Pages : 605-614

Doi:10.18663/tjcl.1822329

View : 40 | Download : 133

Publication Date : 2026-01-01

Article Type : Research Paper

Abstract :Background: Systemic inflammation and nutritional status are key determinants of prognosis in metastatic clear-cell renal carcinoma (mccRCC). Composite indices such as the Systemic Immune–Inflammation Index (SII) and the Modified Glasgow Prognostic Score (mGPS) have demonstrated prognostic relevance across cancers, but real-world data in mccRCC remain limited. Methods: This retrospective, single-center cohort included patients with histologically confirmed mccRCC who received first-line tyrosine kinase inhibitor (TKI) monotherapy (sunitinib, pazopanib, or cabozantinib) between November 2022 and November 2024 at Etlik City Hospital (Ankara, Türkiye). Associations between inflammatory–nutritional indices (SII, mGPS) and progression-free survival (PFS) were evaluated using Kaplan–Meier and multivariable logistic regression analyses. Results: A total of 55 patients met eligibility criteria and were included in the analysis. The median age was 62 years (IQR 52–71), and 67% were male. Median PFS was 13.24 months (95% CI 7.75–19.12), while median OS was not reached. High SII (≥ 870) was independently associated with shorter PFS in multivariable analysis (OR 5.05; 95% CI 1.14–15.77; p = 0.039). mGPS (1–2) was significantly associated with inferior PFS in Kaplan–Meier analysis (HR 3.43; 95% CI 1.42–8.30; p = 0.006; log-rank p = 0.001), but lost significance in multivariable modeling. Metformin use (OR 0.12; 95% CI 0.02–0.93; p = 0.044), sunitinib therapy (OR 0.07; 95% CI 0.006–0.74; p = 0.027), and favorable/intermediate IMDC risk group (OR 0.17; 95% CI 0.06–0.96; p = 0.047) were independently associated with a lower progression risk. Patients treated with cabozantinib (n = 15) showed a numerically longer median PFS (18.6 months; 95% CI 13.8–23.3) compared with sunitinib (n = 25, 12.2 months; 95% CI 5.5–19.0) and pazopanib (n = 15, 12.1 months; 95% CI 6.7–17.5), although this difference was not statistically significant (log-rank p = 0.152). Conclusion: In this real-world cohort of patients with mccRCC treated with first-line TKI, host-related inflammatory and nutritional status were closely associated with progression-free survival. Additionally, patients classified within the favorable IMDC risk group exhibited a significantly lower risk of progression, highlighting the importance of integrating clinical risk stratification with systemic inflammatory and nutritional markers. Incorporating such easily measurable biomarkers and clinical risk scores into existing prognostic models may enhance individualized risk assessment and therapeutic decision-making. Future prospective, multicenter, randomized controlled, and artificial intelligence–assisted studies are warranted to validate these findings and refine precision oncology approaches in this population.
Keywords : Berrak hücreli metastatik renal karsinom, Enflamasyon, Prognoz, Tirozin kinaz inhibitörleri, Yapay zekâ

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