在过去的几十年里，酪氨酸激酶抑制剂 (TKI)、免疫检查点抑制剂 (ICI) 和免疫组合的出现彻底改变了转移性肾细胞癌 (mRCC) 的治疗方法。 RCC 是异构的，即使是最常用的经过验证的预后系统，也无法描述其在现实生活场景中的演变。我们的目标是识别潜在的易于获得的临床因素并设计病程预测系统。对在两个大容量肿瘤中心接受序贯全身治疗的 453 名 mRCC 患者的医疗记录进行了审查。 Kaplan-Meier法和Cox比例风险模型用于估计和比较组间生存率。作为一线治疗，366 名患者接受 TKI 单药治疗，64 名患者接受 ICI 单独或联合治疗。平均治疗线数为 2.5。高全身炎症指数、体重指数低于 25 Kg/m2、全身治疗开始前存在骨转移、首次诊断时年龄超过 65 岁、非透明细胞组织学和肉瘤样成分与较差的 OS 相关。在治疗顺序中接受联合疗法的患者与仅接受单一疗法的患者之间没有观察到显着的 OS 差异。我们基于病理分期和组织学分级的复发预测系统可以有效预测肾切除术和全身治疗之间的时间。我们的多中心回顾性分析揭示了 mRCC 的其他潜在预后因素（未包含在当前经过验证的预后系统中），提出了一种病程预测模型，并描述了当前可用的最常见治疗策略的结果。© 2024。作者。

Over the last decades, the therapeutic armamentarium of metastatic renal cell carcinoma (mRCC) has been revolutionized by the advent of tyrosin-kinase inhibitors (TKI), immune-checkpoint inhibitors (ICI), and immune-combinations. RCC is heterogeneous, and even the most used validated prognostic systems, fail to describe its evolution in real-life scenarios. Our aim is to identify potential easily-accessible clinical factors and design a disease course prediction system. Medical records of 453 patients with mRCC receiving sequential systemic therapy in two high-volume oncological centres were reviewed. The Kaplan-Meier method and Cox proportional hazard model were used to estimate and compare survival between groups. As first-line treatment 366 patients received TKI monotherapy and 64 patients received ICI, alone or in combination. The mean number of therapy lines was 2.5. A high Systemic Inflammation Index, a BMI under 25 Kg/m2, the presence of bone metastases before systemic therapy start, age over 65 years at the first diagnosis, non-clear-cell histology and sarcomatoid component were correlated with a worse OS. No significant OS difference was observed between patients receiving combination therapies and those receiving exclusively monotherapies in the treatment sequence. Our relapse prediction system based on pathological stage and histological grade was effective in predicting the time between nephrectomy and systemic treatment. Our multicentric retrospective analysis reveals additional potential prognostic factors for mRCC, not included in current validated prognostic systems, suggests a model for disease course prediction and describes the outcomes of the most common therapeutic strategies currently available.© 2024. The Author(s).