Developing and validating an innovative risk stratification model for non-metastatic clear cell renal cell carcinoma patients with venous tumor thrombus

Purpose: Exploring the survival influencing factors in patients with non-metastatic clear cell renal cell carcinoma (ccRCC) and venous tumor thrombus (VTT) is vital for tailored therapies. Our objective was to develop and validate a novel risk scoring system for the patients to predict the survival time and probability. Methods: Data were gathered from non-metastatic ccRCC patients with VTT treated between 2011 and 2024. Participants were retrospectively assigned in a 7:3 ratio to training and testing cohorts. We evaluated and quantified clinicopathological characteristics of the primary tumor (PT) and VTT, constructing multivariable models to predict overall survival (OS). Results: The study included 124 patients, with a median follow-up of 35 months. We developed a risk score system based on PT Sarcomatoid differentiation (p = 0.034), PT perirenal fat invasion (p = 0.046), VTT grade (p = 0.045) and Neutrophil to Lymphocyte Ratio(NLR) (p = 0.007). This system accurately identified a high-risk cohort exhibiting adverse outcomes among non-metastatic ccRCC patients with VTT, findings consistent in the testing group. Conclusion: Our study presents a nomogram integrating clinicopathological features—PT Sarcomatoid differentiation, PT perirenal fat invasion, VTT grade and NLR—facilitating risk stratification and enhancing the precision in managing non-metastatic ccRCC patients with VTT.