Contemporary validation of the renal cell carcinoma inflammatory score (RISK) for preoperative prognostication in non-metastatic renal cell carcinoma

Abstract

The renal cell carcinoma (RCC) inflammatory score (RISK) is a preoperative prognostic model incorporating easily accessible inflammatory markers. This study validates the prognostic value of the RISK score and compares RCC prognostic models in a non-metastatic RCC cohort. METHODS: Following IRB approval, patients from Emory's Nephrectomy Database, undergoing nephrectomy for non-metastatic RCC between 2007-2024 were included. RISK scores were calculated using CRP, albumin, ESR, AST, ALT, and corrected calcium. Scores were classified as baseline (0), low (1-3), intermediate (4-6) and high (7-10) risk. Overall survival (OS) and Disease-Free survival (DFS) were analyzed using Cox proportional hazards models. Time-dependent AUC analyses compared RISK against Stage, Size, Grade and Necrosis (SSIGN), UCLA Integrated Staging System (UISS), and Mayo PFS models at 1-, 3-, 5-, and 10-years. RESULTS: 1056 patients were included. Increasing RISK categories were independently associated with worse DFS and OS. Compared with no/baseline-risk patients, high-risk patients had worse DFS (HR 3.38, 95% CI 1.82-6.29, p