A new prognostic score predicts survival in advanced kidney cancer more accurately than the current standard, a large international study has found.
The Meet-URO score built on the existing International Metastatic RCC Database Consortium (IMDC) score, which is widely used to predict outcomes in metastatic renal cell carcinoma (mRCC). It added two extra measures, the neutrophil-to-lymphocyte ratio and the presence of bone metastases, and split patients into five risk groups instead of three.
Researchers tested the score in 1,418 patients with mRCC who started first-line immune-based combination therapy between January 2019 and May 2024. The cohort came from 31 centres in the UK, Czech Republic, Turkey and China, with most centres based in the UK.
After a median follow-up of 27 months, median overall survival ranged widely across the five Meet-URO groups:
- Group 1 (best prognosis): 46 months
- Group 2: 52 months
- Group 3: 38 months
- Group 4: 20 months
- Group 5 (worst prognosis): 12 months
Three-year survival also fell sharply, from 66% in group one to 26% in group five. Compared with group one, the risk of death was 4.82 times higher in group five.
The IMDC score, by contrast, classified patients into just three groups: 19% favourable-risk, 53% intermediate-risk and 28% poor-risk. Meet-URO outperformed IMDC at predicting both overall survival and progression-free survival, the authors reported.
The new score also broke down the large IMDC intermediate-risk group, which included more than half of patients, into three categories with median overall survival ranging from 19.7 to 51.4 months.
Meet-URO outperformed IMDC in patients treated with two immunotherapy drugs (ICI-ICI) and in those treated with immunotherapy plus a targeted therapy (ICI-TKI), although both scores performed better in the ICI-TKI group, the authors noted.
The authors said Meet-URO could help clinicians have more nuanced conversations with patients about their likely outcomes and the potential benefits of combination therapy, particularly for those in the IMDC intermediate-risk group.
The study was co-led by Dr Aruni Ghose, a clinical fellow in medical oncology at Barts Health NHS Trust, and published in The Oncologist [link here].