An increase in neutrophil-to-lymphocyte ratio (NLR) of 3 or more at 2 months following initiation of therapy for metastatic renal cell carcinoma (mRCC) predicts an increased risk for impending treatment failure and death, study findings presented at the virtual 2021 Genitourinary Cancers Symposium suggest.

The study included 121 patients with mRCC (98 men, 23 women) who had complete data on NLR at baseline and after 2 months on therapy. An NLR of 3 or more (NLR failure) at 2 months was significantly associated with a 6.8-fold increased risk for death in less than 1 year, Arnab Basu, MBBS, MPH, of the University of Alabama at Birmingham, and colleagues reported.

In a model adjusted for NLR change, the value of baseline NLR for predicting OS of less than 1 year was not significant. Baseline NLR did not predict treatment failure in less than 6 months, whereas NLR failure predicted a significant 4.8-fold increased risk for treatment failure in less than 6 months.

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In addition, NLR failure at 2 months had a 78% positive predictive value (PPV) for survival of less than 1 year and 86% PPV for treatment failure at 6 months, according to the investigators.

The cohort included 89 White patients, 15 Black patients, and 17 patients of other races. Of the 121 patients, 92 (81%) had clear cell RCC.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Basu A, Phone A, Bice T, et al. Change in neutrophil to lymphocyte ratio (NLR) as a predictor of treatment failure in renal cell carcinoma patients: Analysis of the IROC (Investigating RCC Outcomes) cohort. Presented at the virtual 2021 Genitourinary Cancers Symposium, February 11 to 13. Abstract 344.