Baseline and three-month De Ritis ratio and gamma-glutamyltransferase as prognostic biomarkers in metastatic renal cell carcinoma treated with targeted therapy

Liver function tests (LFTs)–derived parameters such as the De Ritis ratio (DRR) and gamma-glutamyltransferase (GGT) may reflect tumor biology and systemic inflammation. Thus, we evaluated both baseline and 3-month measurements of LFTs in patients with metastatic renal cell carcinoma (mRCC) receiving first-line targeted therapy (TT). We retrospectively analyzed 264 patients with mRCC treated with first-line TT. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan–Meier and compared using the log-rank test. Associations of clinicopathological variables with PFS and OS were analyzed using univariate and multivariate Cox models. The median PFS and OS times for the cohort were 12.3 months (95% confidence interval [CI]: 10.7–13.8) and 45.6 months (95% CI: 38.4–52.9), respectively. At 3 months, patients with high DRR had inferior PFS (11.5 vs. 13.4 months, p = 0.003) and OS (33.0 vs. 63.0 months, p < 0.001) compared with those with low DRR. Similarly, patients with elevated GGT (> upper limit of normal) demonstrated shorter PFS (10.3 vs. 13.8 months, p < 0.001) and OS (39.4 vs. 55.0 months, p < 0.001). In multivariate analyses, high DRR was an independent predictor of shorter PFS (hazard ratio [HR]: 1.504, 95% CI: 1.126–2.009, p = 0.006) and OS (HR: 2.108, 95% CI: 1.449–3.066, p < 0.001). Elevated GGT was also independently associated with inferior PFS (HR: 1.624, 95% CI: 1.221–2.158, p < 0.001) and OS (HR: 1.661, 95% CI: 1.198–2.303, p = 0.002). Elevated DRR and GGT values at 3 months were independent predictors of inferior PFS and OS in mRCC, underscoring their utility as practical biomarkers that may improve risk stratification in routine clinical care.