Frontiers in oncology · 2026
Prognostic performance of baseline serum immunoglobulin G in patients with metastatic renal cell carcinoma receiving first-line ICI-TKI therapy.
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Wang Hongwei, Bi Xingang, Han Tian, Du Gan, Guan Youyan, Zhou Aiping, Li Changling, Shou Jianzhong, Shi Hongzhe
Аннотация
BACKGROUND: In the era of immune checkpoint inhibitor-tyrosine kinase inhibitor (ICI-TKI) combination therapy for metastatic renal cell carcinoma (mRCC), reliable biomarkers for prognostic stratification and long-term prognosis remain clinically unmet needs. This study aimed to investigate the prognostic significance of baseline serum IgG in patients with mRCC receiving first-line systemic therapy and to evaluate its potential in complementing current risk stratification models.
METHODS: We retrospectively analyzed 153 patients with mRCC receiving first-line ICI-TKI therapy between May 2019 and April 2026. Baseline serum IgG levels were categorized as elevated (>17.4 g/L) or normal based on the institutional reference limit. Survival outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazards models. A prognostic nomogram was developed for individualized survival prediction.
RESULTS: The median follow-up was 29.0 months. Elevated baseline IgG was associated with higher IMDC risk (P = 0.022). Kaplan-Meier analysis showed significantly worse overall survival (OS; P < 0.001) and progression-free survival (PFS; P = 0.049) in patients with elevated IgG. In multivariable analysis, elevated IgG was not associated with PFS but remained an independent predictor of inferior OS (HR = 2.55; 95% CI, 1.30-5.00; P = 0.006). Incorporating IgG into the IMDC model improved the C-index from 0.645 to 0.689, with the greatest incremental benefit observed for 3-year OS prediction. The exploratory nomogram demonstrated acceptable calibration, particularly for 3-year OS prediction.
CONCLUSIONS: Baseline serum IgG is an independent prognostic biomarker for OS in mRCC patients treated with first-line ICI-TKI therapy. Its integration into the IMDC model improves survival prediction and provides additional prognostic information in the immunotherapy era.
METHODS: We retrospectively analyzed 153 patients with mRCC receiving first-line ICI-TKI therapy between May 2019 and April 2026. Baseline serum IgG levels were categorized as elevated (>17.4 g/L) or normal based on the institutional reference limit. Survival outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazards models. A prognostic nomogram was developed for individualized survival prediction.
RESULTS: The median follow-up was 29.0 months. Elevated baseline IgG was associated with higher IMDC risk (P = 0.022). Kaplan-Meier analysis showed significantly worse overall survival (OS; P < 0.001) and progression-free survival (PFS; P = 0.049) in patients with elevated IgG. In multivariable analysis, elevated IgG was not associated with PFS but remained an independent predictor of inferior OS (HR = 2.55; 95% CI, 1.30-5.00; P = 0.006). Incorporating IgG into the IMDC model improved the C-index from 0.645 to 0.689, with the greatest incremental benefit observed for 3-year OS prediction. The exploratory nomogram demonstrated acceptable calibration, particularly for 3-year OS prediction.
CONCLUSIONS: Baseline serum IgG is an independent prognostic biomarker for OS in mRCC patients treated with first-line ICI-TKI therapy. Its integration into the IMDC model improves survival prediction and provides additional prognostic information in the immunotherapy era.