Altıntaş Yunus Emre, Kınıkoğlu Oğuzcan, Işık Deniz, Güneş Tuğçe Kübra, Özkerim Uğur, Basoglu Tuğba, Sürmeli Heves, Odabaş Hatice, Turan Nedim
Department of Medical Oncology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul 34865, Türkiye.
Department of Medical Oncology, Ümraniye Training and Research Hospital, Istanbul 34760, Türkiye.
Cancers (Basel). 2025 Mar 23;17(7):1076. doi: 10.3390/cancers17071076.
: Metastatic renal cell carcinoma (mRCC) is a heterogeneous disease requiring precise risk stratification for optimal treatment selection. The International Metastatic RCC Database Consortium (IMDC) model classifies patients into favorable-, intermediate-, and poor-risk groups; however, emerging evidence suggests that the favorable-risk category encompasses patients with distinct prognoses. This study aims to evaluate whether subclassifying favorable-risk mRCC into "very favorable" and "favorable" subgroups improves prognostic accuracy and informs treatment strategies. : This retrospective cohort study analyzed 189 patients diagnosed with mRCC at a single tertiary center between 2017 and 2023. Based on IMDC criteria, 75 patients were classified as favorable risk and included in the final analysis. These patients were further stratified into very favorable ( = 29) and favorable ( = 46) groups based on time from diagnosis to systemic therapy, Karnofsky performance status, and presence of metastases at specific sites. Kaplan-Meier analysis and Cox proportional hazards regression models were used to assess progression-free survival (PFS) and overall survival (OS). : Patients in the very favorable group demonstrated significantly longer median PFS (22.8 vs. 13.8 months, HR: 0.55, = 0.020) and OS (74.4 vs. 42.7 months, HR: 0.38, = 0.013) compared to the favorable group. In multivariate analysis, very-favorable-risk classification remained an independent prognostic factor for OS ( = 0.014) but not for PFS ( = 0.071). : Stratifying favorable-risk mRCC patients into very favorable and favorable subgroups enhances prognostic assessment, potentially guiding more tailored treatment strategies. These findings highlight the need for refined risk models to improve personalized management in mRCC.
转移性肾细胞癌（mRCC）是一种异质性疾病，需要进行精确的风险分层以选择最佳治疗方案。国际转移性RCC数据库联盟（IMDC）模型将患者分为低危、中危和高危组；然而，新出现的证据表明，低危组包含预后不同的患者。本研究旨在评估将低危mRCC进一步细分为“极低危”和“低危”亚组是否能提高预后准确性并为治疗策略提供依据。 这项回顾性队列研究分析了2017年至2023年期间在单个三级中心诊断为mRCC的189例患者。根据IMDC标准，75例患者被分类为低危，并纳入最终分析。根据从诊断到全身治疗的时间、卡诺夫斯基体能状态以及特定部位转移灶的存在情况，将这些患者进一步分为极低危（n = 29）和低危（n = 46）组。采用Kaplan-Meier分析和Cox比例风险回归模型评估无进展生存期（PFS）和总生存期（OS）。 与低危组相比，极低危组患者的中位PFS（22.8个月对13.8个月，HR：0.55，P = 0.020）和OS（74.4个月对42.7个月，HR：0.38，P = 0.013）显著更长。在多变量分析中，极低危风险分类仍然是OS的独立预后因素（P = 0.014），但不是PFS的独立预后因素（P = 0.071）。 将低危mRCC患者分为极低危和低危亚组可增强预后评估，可能指导更具针对性的治疗策略。这些发现凸显了需要改进风险模型以改善mRCC的个性化管理。
