C-Reactive Protein/Albumin Ratio (CAR)-Integrated IMDC Model Improves Risk Stratification in Metastatic Renal Cell...

Area of Science:

• Oncology
• Biomarkers
• Prognostic Models

Background:

• Metastatic renal cell carcinoma (mRCC) prognosis is complex.
• The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model is a standard prognostic tool.
• The C-reactive protein/albumin ratio (CAR) is a potential inflammation biomarker.

Purpose of the Study:

• To assess the added value of the C-reactive protein/albumin ratio (CAR) to the IMDC prognostic model for mRCC.
• To refine patient selection for cytoreductive nephrectomy (CN) in mRCC.
• To improve overall survival (OS) and all-cause mortality (ACM) prediction.

Main Methods:

• Retrospective multicenter analysis of 392 mRCC patients.
• Receiver operating characteristic (ROC) analysis to determine optimal CAR cutoff (≥2.53).
• Cox multivariable analysis (MVA) and Kaplan-Meier analysis (KMA) for survival prediction and model assessment (C-index).

Main Results:

• High CAR (HCAR) (≥2.53) was an independent predictor of ACM (HR = 1.84, p < 0.001).
• The CAR-augmented IMDC model showed improved predictive accuracy (C-index = 0.70) compared to IMDC alone (C-index = 0.67).
• CAR integration refined risk stratification, aligning favorable-risk/high-CAR with intermediate-risk/normal-CAR, and intermediate-risk/high-CAR with poor-risk.

Conclusions:

• Integrating CAR into the IMDC model significantly enhances prognostic precision for mRCC.
• The CAR-augmented model better identifies patients suitable for CN, particularly intermediate-risk patients with normal CAR.
• This approach helps spare intermediate-risk patients with high CAR from potentially non-beneficial surgery.