Baseline and dynamic changes in skeletal muscle mass as predictive biomarkers in patients with metastatic renal cell carcinoma treated with Nivolumab

Predictive Value of Sarcopenia in mRCC

Abstract

Background: Sarcopenia, defined as a loss of skeletal muscle mass and function, has been increasingly recognized as a negative prognostic factor in oncology. This study aimed to investigate whether sarcopenia, evaluated both before and during immunotherapy, could predict treatment response and survival in patients with metastatic renal cell carcinoma (mRCC) treated with Nivolumab.

Materials and methods: This retrospective cohort study included 50 mRCC patients who received Nivolumab between 2019 and 2022 and underwent abdominal computed tomography (CT) before and after treatment. Sarcopenia was assessed by calculating the skeletal muscle index (SMI) at the third lumbar vertebra using standard Hounsfield unit thresholds (−29 to +150 HU). Treatment response was evaluated according to immune Response Evaluation Criteria in Solid Tumors (iRECIST). Overall survival (OS) and progression-free survival (PFS) were analyzed using Kaplan–Meier curves and Cox regression models.

Results: Sarcopenia was identified in 60% of patients and was significantly associated with multiple organ metastases (p = 0.003). Patients with sarcopenia or a negative change in SMI during treatment demonstrated poorer treatment response (p = 0.027 and p = 0.021, respectively). Both OS and PFS were significantly shorter in sarcopenic patients and those with declining muscle mass.

Conclusions: Pre-treatment sarcopenia and muscle loss during immunotherapy were independently associated with inferior survival and treatment response in mRCC patients receiving Nivolumab. Sarcopenia may serve as an imaging-based prognostic biomarker in this population.

Keywords: Renal cell carcinoma; Sarcopenia; Nivolumab; Prognosis; Immunotherapy; Computed tomography