Risk stratification for recurrence after nephrectomy in high-risk renal cell carcinoma patients

To identify prognostic factors that guide adjuvant therapy decisions, we investigated factors predicting recurrence in patients with high-risk clear cell renal cell carcinoma (RCC) after nephrectomy.

We retrospectively reviewed patients with non-metastatic, high-risk clear cell RCC who underwent radical or partial nephrectomy at our institution and affiliated centers between January 2016 and March 2024. Multivariate analysis using the Cox proportional hazards model was performed to identify clinicopathological factors associated with recurrence. On the basis of these factors, we developed a risk stratification model.

A total of 338 patients were included. The 5-year recurrence-free survival (RFS) rate was 54.3%. Multivariate analysis identified a body mass index of ≤ 22 kg/m² (Hazard Ratio [HR]: 2.61), rhabdoid differentiation (HR: 5.14), anemia (HR: 1.97), hypercalcemia (HR: 2.67), and C-reactive protein ≥ 0.5 mg/dL (HR: 1.72) as independent predictors of recurrence. RFS was significantly different between patients with varying numbers of risk factors: 3-year RFS rates were 22.6% for those with 3-4 factors, 47.9% for those with two, 75.5% for those with one, and 83.6% for those with none.

We identified independent predictors of recurrence in patients with nephrectomy-treated clear cell RCC. Patients stratified according to a risk score based on these factors had different recurrence rates, suggesting that this score could assist in guiding adjuvant therapy decisions.