Contemporary Validation of the Renal Cell Carcinoma Inflammatory Score for Preoperative Prognostication in Nonmetastatic Renal Cell Carcinoma.

INTRODUCTION

The Renal Cell Carcinoma (RCC) Inflammatory Score (RISK) is a preoperative prognostic model incorporating easily accessible inflammatory markers. This study validates the prognostic value of the RISK score and compares RCC prognostic models in a nonmetastatic RCC cohort.

METHODS

Following Institutional Review Board approval, patients from Emory's Nephrectomy Database undergoing nephrectomy for nonmetastatic RCC between 2007 and 2024 were included. RISK scores were calculated using C-reactive protein, albumin, erythrocyte sedimentation rate, aspartate aminotransferase, alanine aminotransferase, and corrected calcium. Scores were classified as baseline (0), low (1-3), intermediate (4-6), and high (7-10) risk. Overall survival (OS) and disease-free survival (DFS) were analyzed using Cox proportional hazards models. Time-dependent AUC analyses compared RISK against SSIGN (Stage, Size, Grade and Necrosis), UISS (University of California Los Angeles Integrated Staging System), and Mayo DFS models at 1, 3, 5, and 10 years.

RESULTS

A total of 1056 patients were included. Increasing RISK categories were independently associated with worse DFS and OS. Compared with no/baseline-risk patients, high-risk patients had worse DFS (HR 3.38, 95% CI 1.82-6.29, P < .001) and OS (HR 2.54, 95% CI 1.28-5.03, P = .007). For DFS and OS, RISK demonstrated comparable discrimination against SSIGN, UISS, and Mayo DFS. The combination of the RISK model with the Mayo DFS model resulted in superior DFS AUC at 5 and 10 years postoperatively compared with Mayo DFS alone.

CONCLUSIONS

Elevated RISK groups were independently associated with poor DFS and OS among patients with nonmetastatic RCC, demonstrating discrimination comparable with established models. Pending validation, the addition of RISK to existing models may enhance prognostication and counselling.