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The NLR was assessed at baseline (BL), within 7 days (D7), and 1 month (M1) after treatment initiation. Patients were classified into three groups according to NLR at BL and at D7 as follows: BL NLR low (&lt;\u20093), NLR high-low (BL NLR\u2009\u2265\u20093 and D7 NLR\u2009&lt;\u20093), and NLR high-high (BL NLR\u2009\u2265\u20093 and D7 NLR\u2009\u2265\u20093) groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 198 patients were included in the study, with a median follow-up of 18.0 months. The median NLR changed during follow-up at BL, D7, and M1 (BL, 3.28; D7, 3.23; M1, 2.74). OS stratified by NLR at each time point was significant at BL and D7, but not at M1. Among patients with BL NLR\u2009\u2265\u20093 (55%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009109), 26 patients (24%) had D7 NLR\u2009&lt;\u20093. The 2\u00a0year OS rates were 83.7, 85.5, and 66.0% for patients in the low-, high-low-, and high-high groups, respectively. Multivariate analysis revealed that high NLR was an independent risk factor associated with worse OS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The combination of BL NLR and D7 NLR identified high-risk patients with aRCC treated with first-line immune checkpoint inhibitor therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10147-026-03115-x","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T12:35:58Z","timestamp":1783773358000},"page":"1984-1994","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combination of baseline and first-week neutrophil-to-lymphocyte ratio predicts overall survival in advanced renal cell carcinoma treated with first-line combination immunotherapy"],"prefix":"10.1007","volume":"31","author":[{"given":"Takeshi","family":"Sasaki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichiro","family":"Higashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kouhei","family":"Nishikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Iinuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keita","family":"Nakane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoki","family":"Taniguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuta","family":"Sano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aika","family":"Matsuyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaori","family":"Ozawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Tochigi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masataka","family":"Tamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuaki","family":"Kubota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shusuke","family":"Akamatsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Koie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,11]]},"reference":[{"issue":"1","key":"3115_CR1","doi-asserted-by":"publisher","first-page":"35526","DOI":"10.1038\/s41598-025-19523-4","volume":"15","author":"K Iinuma","year":"2025","unstructured":"Iinuma K, Sano Y, Nishikawa K, Taniguchi T, Matsuyama A, Ozawa K, Ishida T, Tochigi K, Tamura M, Kubota Y, Akamatsu S, Inoue T, Koie T (2025) Efficacy and safety of combination immunotherapy for treating advanced non-clear cell renal cell carcinoma: a multicenter retrospective study in Japan. 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H2023-235).","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The requirement for informed consent was waived because this was a retrospective observational study.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":4,"name":"Ethics","label":"Animal rights","group":{"name":"EthicsHeading","label":"Declarations"}}]}}