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Here, we evaluated the prognostic potential of ALAT, ASAT, GGT and LDH in a larger multicentric real-world cohort. Baseline levels of ALAT, ASAT, GGT and LDH from 240 patients with mRCC undergoing immune-based 1L therapy were retrospectively investigated regarding progression-free survival (PFS), overall survival (OS) and response rates. Independent prognostic factors for PFS and OS were identified via multivariate Cox regression analyses. Although none of the serum parameters were markedly associated with therapy response, patients with low LDH showed a significantly longer PFS. Furthermore, patients with low GGT and LDH also exhibited a significantly prolonged OS. The combination of GGT and LDH risk groups enhanced the prognostic power. The concomitant elevation of both GGT and LDH was significantly associated with a higher progression rate and increased overall mortality and subsequently identified as independent prognosticator for PFS and OS. Overall, the prognostic potential of baseline GGT and LDH serum levels was substantiated in a larger multicentric cohort of patients with mRCC undergoing immune-based 1L therapy.<\/jats:p>","DOI":"10.1038\/s41598-026-48270-3","type":"journal-article","created":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T11:15:21Z","timestamp":1776510921000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined elevation of pre-treatment \u03b3-glutamyltransferase and lactate dehydrogenase as independent prognosticator for metastatic renal cell carcinoma undergoing immune-based 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