Relevance of the IMDC Risk Model in a Real World Setting: A Single Institution Experience

This single-centre retrospective study evaluated outcomes in 112 patients with metastatic renal cell carcinoma (mRCC) treated with first-line VEGF-TKIs or immune checkpoint inhibitor (IO)-based combinations. The primary objective of this study was to evaluate survival outcomes of mRCC patients according to IMDC risk stratification in the modern systemic treatment era. A secondary aim was to assess whether prior nephrectomy provides an independent prognostic advantage when adjusted for an IMDC risk category. This study highlights that the IMDC risk classification remains a strong and reliable prognostic tool for predicting survival outcomes in mRCC patients treated with modern VEGF TKI and IO-based therapies, with median overall survival (OS) of 87, 36, and 9 months in favourable-, intermediate-, and poor-risk patients, respectively. Prior nephrectomy appeared to improve OS (55 vs. 21 months) and progression-free survival (29 vs. 10.9 months) on unadjusted analysis; however, this association was attenuated and no longer statistically significant after adjusting for IMDC risk groups, reflecting strong baseline imbalances and indicating that any true independent benefit is uncertain and requires confirmation in larger cohorts.