Clinical utility of combining the C-reactive protein-to-albumin ratio and systemic immune-inflammation index for prognostic assessment in metastatic renal cell carcinoma
4 affiliations
- 1Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
- 2Human Disease Models, Institute of Laboratory Animals, Tokyo Women’s Medical University, Tokyo, Japan
- 3Data Science and Informatics for Genetic Disorders, Juntendo University, Graduate School of Medicine, Tokyo, Japan
- 4Innovative Longevity, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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.
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BibTeX
@article{muramoto2026clinical,
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}},
author = {Nobuhito Muramoto and Masayoshi Nagata and Hisashi Hirano and Tomoya Shirakawa and Toshiyuki China and Haruna Kawano and Shuji Isotani and Hisamitsu Ide and Hiroaki Honda and Shigeo Horie},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0345724},
url = {https://doi.org/10.1371/journal.pone.0345724},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical utility of combining the C-reactive protein-to-albumin ratio and systemic immune-inflammation index for prognostic assessment in metastatic renal cell carcinoma
AU - Nobuhito Muramoto
AU - Masayoshi Nagata
AU - Hisashi Hirano
AU - Tomoya Shirakawa
AU - Toshiyuki China
AU - Haruna Kawano
AU - Shuji Isotani
AU - Hisamitsu Ide
AU - Hiroaki Honda
AU - Shigeo Horie
PY - 2026
DA - 2026/10/07
JO - PLOS One
DO - 10.1371/journal.pone.0345724
UR - https://doi.org/10.1371/journal.pone.0345724
AB - 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.
SN - 1932-6203
ER -