Introduction: This study was conducted to investigate the relationships between the effect of sunitinib and immature microvessels which are not covered by pericytes. Materials and Methods: This study involved 29 patients with clear-cell renal cell carcinoma (RCC) who took sunitinib after radical nephrectomy or biopsy due to metastatic RCC. Associations among clinicopathological factors, responses to sunitinib, and patient survival were reviewed. CD31 was used to stain endothelial cells, and anti-α-smooth muscle actin was used to stain pericytes. Immature vessels were defined as vessels that were positive only for CD31 staining. A high pericyte coverage was defined as a rate of pericyte coverage above 40%. Results: Partial responses, disease stabilization, and disease progression constituted 51.7, 10.4, and 37.9% of cases, respectively. Nine cases had a low pericyte coverage (31.0%). In the high-pericyte-coverage group, the number of metastatic sites was smaller (p = 0.003). The overall response rate to sunitinib was greater in the high-pericyte-coverage group than in the low-pericyte-coverage group (p = 0.027). The median overall survival and the median progression-free survival were not significantly different between the high- and low-pericyte-coverage groups. Conclusion: In the high-pericyte-coverage group, the overall response rates to sunitinib were higher, and the numbers of metastatic sites were smaller.

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