Preoperative thymic output and T cell repertoire diversity are associated with recurrence after nephrectomy for localized renal cell carcinoma

Radiographic thymic health and peripheral T-cell repertoire features have been linked to outcomes in renal cell carcinoma (RCC), but their prognostic value after curative-intent surgery is unclear. We quantified preoperative blood signal-joint T-cell receptor excision circles (sjTRECs), a marker of thymic output, in 218 patients with localized RCC undergoing nephrectomy and characterized T-cell receptor β (TCRβ) repertoires in 201 patients. We assessed overall survival (OS) and recurrence-free survival (RFS) using Kaplan-Meier and Cox models adjusted for age, sex, and Leibovich risk group. High sjTREC levels were associated with longer RFS after adjustment for age, sex, and Leibovich risk group (hazard ratio [HR] 0.50; 95% confidence interval [CI], 0.29-0.87; p=0.015), with a concordant OS estimate (HR 0.62; 95% CI, 0.38-1.02; p=0.058). sjTREC provided additional prognostic information beyond Leibovich risk stratification for recurrence overall and among intermediate/high-risk patients (likelihood-ratio test, p=0.024 and p=0.034, respectively). Higher TCRβ diversity was associated with longer RFS overall (HR 0.76; 95% CI, 0.60-0.96; p=0.024) and among intermediate/high-risk patients with longer RFS (HR 0.71; 95% CI, 0.55-0.92; p=0.009) and OS (HR 0.80; 95% CI, 0.65-0.98; p=0.031). Preoperative sjTREC provided prognostic information beyond clinicopathological risk, with higher TCRβ diversity associated with favorable outcomes.