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Updated: May 14, 2026
Comparing Metastatic Clear Cell Renal Cell Carcinoma Model Established in Mouse Kidney and on Chicken Chorioallantoic Membrane
Published on: February 8, 2020
C-Reactive Protein/Albumin Ratio (CAR)-Integrated IMDC Model Improves Risk Stratification in Metastatic Renal Cell
Aaron I Ahdoot1, Cesare Saitta1, Giuseppe Garofano1
1Department of Urology, UC San Diego School of Medicine, San Diego, CA 92093, USA.
Abstract:
Background/Objectives: To evaluate the utility of the addition of C-reactive protein/albumin ratio (CAR) to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC). Methods: A retrospective multicenter analysis was conducted. The main outcomes were overall survival (OS) and all-cause mortality (ACM). Receiver operating characteristic (ROC) analysis determined the optimal CAR cutoff. Cox multivariable analysis (MVA) identified independent predictors for ACM. Kaplan-Meier analysis (KMA) evaluated OS stratified by IMDC risk groups. C-index assessed predictive accuracy of the CAR-augmented model. Results: We analyzed 392 patients (80 favorable-IMDC, 298 intermediate-IMDC, and 14 poor-risk). ROC revealed an optimal elevated CAR as ≥2.53. High CAR (HCAR) was an independent predictor of ACM on MVA (HR = 1.84, p < 0.001). KMA comparing IMDC favorable/intermediate/poor-risk revealed 3-year OS of 86.8%/57.9%/50.0%, p = 0.001. Subdivision by CAR revealed alignment between favorable-HCAR with intermediate-normal-CAR (NCAR) and intermediate-HCAR with poor-risk. KMA with the addition of CAR to the IMDC, demonstrating 3-year OS 91.0%, 72.7%, and 48.4% across favorable, intermediate, and poor-risk, respectively. Based on the alignment of favorable-HCAR with intermediate-NCAR, and intermediate-HCAR with poor-risk, a CAR-augmented IMDC algorithm was developed in which favorable- and intermediate-risk patients with NCAR are considered suitable CN candidates, while intermediate-HCAR and poor-risk patients are unlikely to benefit from surgery. The CAR augmented model showed improved predictive capability compared to the IMDC with a C-index of 0.70 vs. 0.67. Conclusions: Integrating CAR into the IMDC model enhances prognostic precision for CN selection in mRCC. This approach identifies intermediate-NCAR as appropriate CN candidates based on favorable survival, while sparing intermediate-HCAR from surgery.
