Effective risk stratification is essential for guiding treatment decisions in patients with metastatic renal cell carcinoma (mRCC). The Meet-URO score is a novel prognostic model that integrates the IMDC criteria with neutrophil-to-lymphocyte ratio (NLR) and the presence of bone metastases. Developed in the immunotherapy era, it has demonstrated superior prognostic accuracy compared to IMDC score across various clinical settings and treatment strategies. Its validation in the context of first-line immune-based combinations has been awaited.
External validation of Meet-URO was performed using a large retrospective real-world cohort of mRCC patients treated with first-line immune-based combinations. Secondary analyses included a comparison with the IMDC score for predicting overall survival (OS) and progression-free survival (PFS). Additionally, restricted mean survival time (RMST) was assessed.
1,418 patients were included in the analysis: 54% received ICI-ICI regimen (nivolumab plus ipilimumab), while 46% received ICI-TKI combination. At baseline, 52.5% of patients had an NLR ≥ 3.2, and 32% had bone metastases. After a median follow-up of 26.8 months, the median OS and median PFS were 34.7 and 11.3 months respectively. Meet-URO demonstrated effective prognostic stratification, identifying patient groups with markedly different outcomes (median OS 11.5-51.4 months; 3-year OS 26-66%; RMST 20.0-42.8 months). Compared to IMDC, Meet-URO showed a significantly better OS (c-index 0.675 vs. 0.643; Δc = 0.032, p < 0.001) and PFS (c-index 0.60 vs. 0.58; p < 0.001) prediction performance.
: Meet-URO demonstrated robust prognostic accuracy. Its integration into routine clinical practice and use as a stratification factor in clinical trials may support more personalized treatment strategies and enhance clinical trial design.
The oncologist. 2026 May 20 [Epub ahead of print]
Sara Elena Rebuzzi, Aruni Ghose, Sarah Rudman, Balaji Venugopal, Kate Young, Ricky Dylan Frazer, Olubukola Ayodele, Mark Stares, Brent O'Carrigan, Waqas Ali, John McGrane, Ankit Jain, Ondrej Fiala, Vishwani Chauhan, Agnieszka Michael, Anjali Zarkar, Gaurav Kapur, Natalie Charnley, Mehran Afshar, Salil Vengalil, Caroline Forde, Janet Brown, Yüksel Urun, Diletta Bianchini, Amit Bahl, Narayanan Srihari, Fabrizio Di Costanzo, Benjamin Smalley, Joanne Parkes, Simon Crabb, Naveen Vasudev, Alexandr Poprach, Nicholas Brown, Lijo James, Sophia Haywood, Jose Tapia, Anupama Vijay, Jane Parry, Michael Cheung, Ishika Mahajan, Niall O Moon, Ritika Abrol, Michaela Tkadlecová, Yamin Shwe Yee Soe, Anum Zargham, Michelle Smith, Sophie Ashley, Orla Hardy, Grisma Patel, Kyaw Kyaw Tun, Emma Johnston, Abdullah Sarwer, Hatice Bölek, Roshani Shrestha, Amarnath Challapalli, James Meegan, Shobana Anpalakhan, Francesco Buono, Eva Kolarikova, David Ka-Wai Leung, Veronica Murianni, Fabio Catalano, Davide Bimbatti, Sebastiano Buti, Alessio Signori, Giuseppe Fornarini, Pasquale Rescigno, Jeremy Yuen Chun Teoh, Giuseppe Luigi Banna
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