Stratification system with dual human endogenous retroviruses for predicting immunotherapy efficacy in metastatic clear-cell renal cell carcinoma.

While these findings did not reach statistical significance—likely due to the limited sample size—they align with recent reports suggesting these factors as potential predictors of ICI response. 35 36 Furthermore, the high-risk H17L4 may harbor a slightly greater presence of immunosuppressive agents such as Tregs and MDSCs, alongside elevated levels of exhaustion markers ( CTLA4 , PDCD1 , LAG3 ) compared with the low-risk L17H4 in the CheckMate cohort (all, p<0.1), while statistical significance was not reached in BIONIKK cohort ( online supplemental figure S4 ).

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