ArticleFrontiers in oncology2026
Prognostic performance of baseline serum immunoglobulin G in patients with metastatic renal cell carcinoma receiving first-line ICI-TKI therapy.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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.
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