Aristolochic acid-related renal cell carcinoma exhibits a distinct tumor immune microenvironment and may be more responsive to immune checkpoint blockade

We aimed to investigate the immune profile of AA-related RCC and explore its potential role as a predictive biomarker for ICB. Three distinct clusters were found through functional pathway analysis using the NanoString gene expression panel. AA-positive ccRCC comprised the majority of cluster 1 and 3, and the two patients with good response to ICB were grouped to Cluster 3. Cluster 3 exhibited higher tumor inflammation signature (TIS) and immune cell type scores. Tissue samples from two patients with metastatic RCC (mRCC) who responded well to ICB and twenty-two additional tumor-normal tissue paired clear cell renal cell carcinoma (ccRCC) were profiled for gene expressions using NanoString PanCancer IO360.