Refining prognosis in advanced renal cell carcinoma: international real-world validation of the Meet-URO score in first-line immunotherapy combinations
Rebuzzi, Sara Elena Ghose, Aruni Rudman, Sarah Venugopal, Balaji Young, Kate Frazer, Ricky Dylan Ayodele, Olubukola Stares, Mark O'Carrigan, Brent Ali, Waqas
Rebuzzi, Sara Elena
Ghose, Aruni
Rudman, Sarah
Venugopal, Balaji
Young, Kate
Frazer, Ricky Dylan
Ayodele, Olubukola
Stares, Mark
O'Carrigan, Brent
Ali, Waqas
Abstract
BBackground: 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.
Methods: 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.
Results: 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.
Conclusions: : 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.
MIDER Authors
Affiliations
Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Barts Health NHS Trust; Guy's and St Thomas' NHS Foundation Trust; NHS Greater Glasgow and Clyde; The Royal Marsden NHS Foundation Trust; Velindre University NHS Trust; University Hospitals of Leicester NHS Trust; NHS Lothian; Cambridge University Hospitals NHS Foundation Trust; United Lincolnshire Hospitals NHS Trust; Royal Cornwall Hospitals NHS Trust; Royal Wolverhampton NHS Trust; University Hospital in Pilsen; Charles University Prague; Royal Surrey NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; Norfolk and Norwich University Hospitals NHS Foundation Trust; Lancashire Teaching Hospitals NHS Foundation Trust; St George's University Hospitals NHS Foundation Trust; University Hospital North Midlands NHS Trust; Belfast Health and Social Care Trust; Sheffield Teaching Hospitals NHS Foundation Trust; Ankara University; Maidstone and Tunbridge Wells NHS Trust; University Hospitals Bristol NHS Foundation Trust; Shrewsbury and Telford Hospital NHS Trust; Newcastle University; University of Naples Federico II; Portsmouth Hospitals University NHS Trust; University of Portsmouth; Worcestershire Acute Hospitals NHS Trust; University Hospital Southampton NHS Foundation Trust; Leeds Teaching Hospitals NHS Trust; Masaryk University; Masaryk Memorial Cancer Institute; Chinese University of Hong Kong; Ospedale "Borea" di Sanremo; University Hospital of Parma; Istituto Oncologico Veneto-IOV IRCCS; University of Parma; University of Genova; IRCCS Ospedale Policlinico San Martino
Date
2026-05-20
Type
Article
Collections
Citation
Rebuzzi SE, Ghose A, Rudman S, Venugopal B, Young K, Frazer RD, Ayodele O, Stares M, O'Carrigan B, Ali W, McGrane J, Jain A, Fiala O, Chauhan V, Michael A, Zarkar A, Kapur G, Charnley N, Afshar M, Vengalil S, Forde C, Brown J, Urun Y, Bianchini D, Bahl A, Srihari N, Di Costanzo F, Smalley B, Parkes J, Crabb S, Vasudev N, Poprach A, Brown N, James L, Haywood S, Tapia J, Vijay A, Parry J, Cheung M, Mahajan I, Moon NO, Abrol R, Tkadlecová M, Yee Soe YS, Zargham A, Smith M, Ashley S, Hardy O, Patel G, Tun KK, Johnston E, Sarwer A, Bölek H, Shrestha R, Challapalli A, Meegan J, Anpalakhan S, Buono F, Kolarikova E, Leung DK, Murianni V, Catalano F, Bimbatti D, Buti S, Signori A, Fornarini G, Rescigno P, Chun Teoh JY, Banna GL. Refining Prognosis in Advanced Renal Cell Carcinoma: International Real-World Validation of the Meet-URO Score in First-Line Immunotherapy Combinations. Oncologist. 2026 May 20:oyag203. doi: 10.1093/oncolo/oyag203. Epub ahead of print.