Circulating IL-6 and survival outcomes in renal cell carcinoma: a systematic review and meta-analysis
Abstract
Introduction & Objectives: Renal cell carcinoma (RCC) represents the majority of kidney malignancies and is characterized by variable outcomes, even with current systemic therapies. Interleukin-6 (IL-6), a proinflammatory cytokine implicated in tumor progression and immune suppression, has been proposed as a prognostic biomarker in RCC. However, the evidence remains inconsistent due to methodological heterogeneity across studies. Therefore, our study aims to evaluate the prognostic significance of IL-6 in RCC by synthesizing data from published studies, specifically overall survival (OS) and progression-free survival (PFS).
Methods: A systematic meta-analysis was conducted to evaluate the prognostic significance of IL-6 in RCC. Eligible studies were identified through PubMed, ScienceDirect, and ProQuest up to March 2025. Inclusion criteria encompassed original articles measuring pre-treatment serum IL-6 levels in RCC patients and reporting associations with overall survival (OS) or progression-free survival (PFS). Random-effects models were used to compute pooled hazard ratios (HRs) and survival differences.
Results: Nine studies comprising 702 RCC patients were included. Patients with low IL-6 levels had significantly longer OS (difference: 5.36 months; 95% CI: 2.2-8.53; p<0.001; I² = 0%) and PFS (difference: 6.41 months; 95% CI: 1.3-11.53; p=0.01; I² = 48.5%) compared to those with high IL-6. The pooled HR for survival associated with elevated IL-6 was 2.06 (95% CI: -0.23-4.36), with considerable heterogeneity (I² = 89.19%) and borderline statistical significance (p=0.08). Despite variations in study design, sample size, and IL-6 detection methods, elevated IL-6 consistently predicted worse clinical outcomes.
Conclusions: IL-6 is a promising prognostic biomarker in RCC, with elevated levels associated with significantly poorer OS and PFS.
References
- 1. Hsieh J, Purdue M, Signoretti S, et al. Renal cell carcinoma. Nat Rev Dis Prim 2018; 9:1-42.
- 2. Petrelli F, Vavassori I, Rossitto M, Dottorini L. Management of metastatic renal cell carcinoma following first-line immune checkpoint therapy failure: a systematic review. Cancers (Basel) 2024;16:2598-610.
- 3. Heidegger I, Pircher A, Pichler R. Targeting the tumor microenvironment in renal cell cancer biology and therapy. Front Oncol 2019;9:1-11.
- 4. Zhao H, Wu L, Yan G, et al. Inflammation and tumor progression: signaling pathways and targeted intervention. Signal Transduct Target Ther 2021; 6:263-308.
- 5. Pilskog M, Bostad L, Edelmann RJ, et al. Tumour cell expression of interleukin 6 receptor α is associated with response rates in patients treated with sunitinib for metastatic clear cell renal cell carcinoma. J Pathol Clin Res 2018; 4:114-23.
- 6. Jian SHI, Wang K, Xiong Z, et al. Impact of inflammation and immunotherapy in renal cell carcinoma (Review). Oncol Lett 2020;20:272-84.
- 7. Gudbrandsdottir G, Aarstad HH, Bostad L, et al. Serum levels of the IL-6 family of cytokines predict prognosis in renal cell carcinoma (RCC). Cancer Immunol Immunother 2021; 70:19-30.
- 8. Pilskog M, Nilsen GH, Beisland C, Straume O. Elevated plasma interleukin 6 predicts poor response in patients treated with sunitinib for metastatic clear cell renal cell carcinoma. Cancer Treat Res Commun 2019; 19:1-5.
- 9. Negrier S, Perol D, Menetrier-Caux C, et al. Interleukin-6, interleukin-10, and vascular endothelial growth factor in metastatic renal cell carcinoma: Prognostic value of interleukin-6 - From the Groupe Français d’Immunothérapie. J Clin Oncol 2004; 22:2371-8.
- 10. Tran HT, Liu Y, Zurita AJ, et al. Prognostic or predictive plasma cytokines and angiogenic factors for patients treated with pazopanib for metastatic renal-cell cancer: A retrospective analysis of phase 2 and phase 3 trials. Lancet Oncol 2012; 13:827-37.
- 11. Thiounn N, Pages F, Flam T, et al. Rapid note: IL-6 is a survival prognostic factor in renal cell carcinoma. Immunol Lett 1997;58:121-4.
- 12. Stadler WM, Richards JM, Vogelzang NJ. Serum interleukin-6 levels in metastatic renal cell cancer: Correlation with survival but not an independent prognostic indicator. J Natl Cancer Inst 1992;84:1835-6.
- 13. Costes V, Liautard J, Picot MC, et al. Expression of the interleukin 6 receptor in primary renal cell carcinoma. J Clin Pathol 1997; 50:835-40.
- 14. Akdogan O, Turkmen S, Uyar G, et al. Impact of serum GDF-15 and IL-6 on immunotherapy response in cancer: a prospective study. Cancers (Basel) 2024;16:41-6.
- 15. Kays JK, Koniaris LG, Cooper CA, et al. The combination of low skeletal muscle mass and high tumor interleukin-6 associates with decreased survival in clear cell renal cell carcinoma. Cancers (Basel) 2020; 12:1605-15.
- 16. Wang Y, Zhang Y. Prognostic role of interleukin-6 in renal cell carcinoma: a meta-analysis. Clin Transl Oncol 2020; 22:835-43.
- 17. Gopinathan G, Milagre C, Pearce OMT, et al. Interleukin-6 stimulates defective angiogenesis. Cancer Res 2015; 75:3098-107.
- 18. Jian Y, Yang K, Sun X, et al. Current Advance of Immune evasion
- mechanisms and emerging immunotherapies in renal cell carcinoma.
- Front. Immunol. 2021; 12:1-21.
- 19. Ishibashi K, Koguchi T, Matsuoka K, et al. Interleukin-6 induces
- drug resistance in renal cell carcinoma. Fukushima J. Med. Sci.
- 2018; 64:103-10.
- 20. Soler MF, Abaurrea A, Azcoaga P, et al. New perspectives in cancer
- immunotherapy: targeting IL-6 cytokine family. J. Immunother.
- Cancer 2023; 11:1-13.
- 21. Sweeney PL, Suri Y, Basu A, et al. Mechanisms of tyrosine kinase
- inhibitor resistance in renal cell carcinoma. Cancer Drug Resist.2023;
- 6:858-73.
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