Prognostic significance of systemic immunoinflammatory biomarkers and pathological features in clear cell renal cell carcinoma: a multicenter study

Background Clear cell renal cell carcinoma (ccRCC) exhibits heterogeneous postoperative outcomes. This study aimed to evaluate systemic immunoinflammatory biomarkers and pathological features and develop an integrated prognostic model for overall survival (OS) in patients with ccRCC.Methods This multicenter retrospective study initially screened 1,662 patients who underwent surgery between January 2010 and December 2024. After excluding 27 patients with substantial missing data, 1,635 were included in baseline analyses, of whom 1,429 with complete data were included in prognostic modeling. Candidate predictors identified by univariable Cox regression were selected using elastic net regression and subsequently evaluated by multivariable Cox regression. Model performance was assessed using the C-index, time-dependent area under the curve (AUC), calibration curves, and decision curve analysis.Results Sixteen variables with p < 0.20 in univariable analyses were considered candidate predictors, and 12 were retained by elastic net regression. ISUP grade, tumor necrosis, platelet count, recurrence/metastasis status, and systemic inflammation response index (SIRI) were independently associated with OS. The nomogram showed good discrimination, with C-indices of 0.849 and 0.869 in the training and internal testing cohorts, respectively. The 1-, 3-, and 5-year AUCs ranged from 0.829 to 0.897. Calibration was satisfactory, and risk stratification identified groups with significantly different survival outcomes (p < 0.001).Conclusions An internally evaluated nomogram integrating systemic inflammatory indices and pathological features demonstrated good prognostic performance for OS in patients with ccRCC.