{
  "abstract": "Background: Inflammation-based biomarkers may refine prognostic stratification in patients with metastatic renal cell carcinoma (mRCC). This study evaluated the prognostic value of the pretreatment C-reactive protein-to-albumin ratio (CAR) and systemic immune-inflammation index (SII) in patients with mRCC receiving first-line systemic therapy. Methods: We retrospectively analyzed 117 patients who received first-line systemic therapy between January 2001 and April 2022. Pretreatment CAR and SII were evaluated as readily available blood-based inflammatory biomarkers. Overall survival (OS) was defined as the primary outcome, and progression-free survival (PFS) was defined as the secondary outcome. Exploratory cutoffs were CAR 0.0731 and SII 533.81. Results: High CAR and high SII were independently associated with shorter OS after adjustment for IMDC risk classification and nephrectomy status. The adjusted HRs were 2.36 for high CAR (95% CI, 1.30–4.27; p = 0.005) and 2.58 for high SII (95% CI, 1.42–4.69; p = 0.002). Patients with concurrent elevation of both CAR and SII had the shortest OS compared with those with neither marker elevated (HR, 6.39; 95% CI, 2.76–14.77; p < 0.001). Adding CAR and SII to International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) improved the optimism-corrected C-index for OS from 0.641 to 0.733. Conclusions: Pretreatment CAR and SII were associated with OS in patients with mRCC receiving first-line systemic therapy. These readily available biomarkers may help refine OS risk assessment when used alongside established clinical factors, but external validation is required before clinical implementation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan",
    "Human Disease Models, Institute of Laboratory Animals, Tokyo Women’s Medical University, Tokyo, Japan",
    "Data Science and Informatics for Genetic Disorders, Juntendo University, Graduate School of Medicine, Tokyo, Japan",
    "Innovative Longevity, Juntendo University, Graduate School of Medicine, Tokyo, Japan"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Nobuhito Muramoto"
    },
    {
      "affs": [
        1
      ],
      "name": "Masayoshi Nagata"
    },
    {
      "affs": [
        2
      ],
      "name": "Hisashi Hirano"
    },
    {
      "affs": [
        3
      ],
      "name": "Tomoya Shirakawa"
    },
    {
      "name": "Toshiyuki China"
    },
    {
      "name": "Haruna Kawano"
    },
    {
      "name": "Shuji Isotani"
    },
    {
      "name": "Hisamitsu Ide"
    },
    {
      "name": "Hiroaki Honda"
    },
    {
      "name": "Shigeo Horie"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3fstkt95qecse.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0345724",
  "fulltext_url": null,
  "id": "3fstkt95qecse",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0345724",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2730|Inflammatory Biomarkers in Disease Prognosis"
    ],
    [
      "plos",
      "/Biology and life sciences/Immunology/Immune response/Inflammation"
    ],
    [
      "plos",
      "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Inflammation"
    ],
    [
      "plos",
      "/Medicine and health sciences/Epidemiology/Medical risk factors/Cancer risk factors"
    ],
    [
      "plos",
      "/Medicine and health sciences/Immunology/Immune response/Inflammation"
    ],
    [
      "plos",
      "/Medicine and health sciences/Nephrology/Renal cancer"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Basic cancer research/Metastasis"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Cancer risk factors"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Cancer treatment"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Cancers and neoplasms/Carcinoma/Renal cell carcinoma"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Cancers and neoplasms/Genitourinary tract tumors/Renal cell carcinoma"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Metastasis"
    ],
    [
      "plos",
      "/Medicine and health sciences/Surgical and invasive medical procedures/Surgical excision/Nephrectomy"
    ],
    [
      "plos",
      "/Medicine and health sciences/Surgical and invasive medical procedures/Urinary system procedures/Nephrectomy"
    ],
    [
      "plos",
      "/Social sciences/Sociology/Consortia"
    ]
  ],
  "openalex": "W7220851356",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0345724&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-07",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/3fstkt95qecse.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:30Z",
      "native_id": "10.1371/journal.pone.0345724",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0345724"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "plos:oncology",
      "subfield": "oncology"
    }
  ],
  "title": "Clinical utility of combining the C-reactive protein-to-albumin ratio and systemic immune-inflammation index for prognostic assessment in metastatic renal cell carcinoma",
  "title_text": "Clinical utility of combining the C-reactive protein-to-albumin ratio and systemic immune-inflammation index for prognostic assessment in metastatic renal cell carcinoma",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:30Z",
  "url": "https://research.draconitic.com/paper/3fstkt95qecse",
  "venue": "PLOS One",
  "versions": []
}