Predicting Survival of Metastatic Clear Cell Renal Cell Carcinoma Treated With Tyrosine Kinase Inhibitor Based Sequential Therapy

(1) Objective: To develop a clinically useful nomogram that may provide a more individualized and accurate estimation of cancer-specific survival (CSS) for patients with clear-cell (CC) metastatic renal cell carcinoma (mRCC) treated with nephrectomy and tyrosine kinase Inhibitor (TKI) based sequential therapy; (2) Methods: A prospectively maintained database of 145 patients with mRCC treated between 2008-2018 was analyzed to predict CSS of patients receiving sunitinib and 2nd and 3rd line therapies according to current standards of practice. A nomogram taking into account four independent clinical predictors (ECOG status, IMDC score, MASS and RECIST response criteria) was calculated. The corresponding 1- to 10-year CSS probabilities were then determined from the nomogram; (3) Results: The median age was 60 years (95% CI 57.9-61.4). Disease was metastatic at diagnosis in 59 (40.7%) and 86 (59.3%) developed metachronous metastasis after nephrectomy. Patients were followed for a median 48 (IQR 72; 95% CI 56-75.7) months after first-line TKI initiation. Concordance probability estimator for the nomogram is 0.778 ± 0.02 (mean ± SE); (4) Conclusions: A nomogram to predict CSS in patients with CC mRCC that incorporates patient status, clinical risk classification and response criteria to first-line TKI at 3 months is presented. This new tool may be useful to clinicians assessing risk and prognosis of patients with mRCC.