Background/Objectives: 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.Methods: 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 (n= 29) and favorable (n= 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).Results: Patients in the very favorable group demonstrated significantly longer median PFS (22.8 vs. 13.8 months, HR: 0.55,p= 0.020) and OS (74.4 vs. 42.7 months, HR: 0.38,p= 0.013) compared to the favorable group. In multivariate analysis, very-favorable-risk classification remained an independent prognostic factor for OS (p= 0.014) but not for PFS (p= 0.071).Conclusions: 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.
背景/目的：转移性肾细胞癌（mRCC）是一种异质性疾病，需要精确的风险分层以选择最佳治疗方案。国际转移性肾细胞癌数据库联盟（IMDC）模型将患者分为良好、中等和不良风险组；然而，新出现的证据表明，良好风险类别包含具有不同预后的患者。本研究旨在评估将良好风险mRCC进一步细分为“极好”和“良好”亚组是否能提高预后准确性并为治疗策略提供依据。 方法：这项回顾性队列研究分析了2017年至2023年间在一家三级中心诊断为mRCC的189例患者。根据IMDC标准，75例患者被归类为良好风险并纳入最终分析。根据从诊断到开始全身治疗的时间、卡氏功能状态评分以及特定部位是否存在转移，这些患者被进一步分为极好风险组（n=29）和良好风险组（n=46）。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）。 结果：与良好风险组相比，极好风险组患者的中位PFS（22.8个月 vs. 13.8个月，HR：0.55，p=0.020）和OS（74.4个月 vs. 42.7个月，HR：0.38，p=0.013）均显著更长。在多变量分析中，极好风险分类仍然是OS的独立预后因素（p=0.014），但对PFS则不然（p=0.071）。 结论：将良好风险mRCC患者细分为极好和良好亚组可增强预后评估，并可能指导更个体化的治疗策略。这些发现强调了需要完善风险模型以改进mRCC的个体化管理。
肿瘤(癌症)患者之家