Contemporary Validation of the Renal Cell Carcinoma Inflammatory Score (RISK) for Preoperative Prognostication in Non-Metastatic Renal Cell Carcinoma.

Authors

Adam Braunschweig, Gabriel Ekene Agu, Reza Lahiji, Dattatraya Patil, Bariş Esen, Luke L Son, William Luke, Taylor A Goodstein, Nahar Imtiaz, Ahmet Yildirim, Michael Moulton, Susan Mumford, Shreyas Joshi, Valentina Grajales, Vikram M Narayan, Reza Nabavizadeh, Mohammad Hajiha, Nazih Khater, Kenneth Ogan, Mehmet A Bilen, Viraj A Master

Published in

Urology practice. Pages 101097UPJ0000000000001040. Jun 15, 2026. Epub Jun 15, 2026.

Abstract

The renal cell carcinoma (RCC) inflammatory score (RISK) is a preoperative prognostic model incorporating easily accessible inflammatory markers. This study validates the prognostic value of the RISK score and compares RCC prognostic models in a non-metastatic RCC cohort.
Following IRB approval, patients from Emory's Nephrectomy Database, undergoing nephrectomy for non-metastatic RCC between 2007-2024 were included. RISK scores were calculated using CRP, albumin, ESR, AST, ALT, and corrected calcium. Scores were classified as baseline (0), low (1-3), intermediate (4-6) and high (7-10) risk. Overall survival (OS) and Disease-Free survival (DFS) were analyzed using Cox proportional hazards models. Time-dependent AUC analyses compared RISK against Stage, Size, Grade and Necrosis (SSIGN), UCLA Integrated Staging System (UISS), and Mayo PFS models at 1-, 3-, 5-, and 10-years.
1056 patients were included. Increasing RISK categories were independently associated with worse DFS and OS. Compared with no/baseline-risk patients, high-risk patients had worse DFS (HR 3.38, 95% CI 1.82-6.29, p < 0.001) and OS (HR 2.54, 95% CI 1.28-5.03, p = 0.007). For DFS and OS, RISK demonstrated comparable discrimination against SSIGN, UISS and Mayo PFS. The combination of the RISK model with the Mayo PFS model resulted in superior DFS AUC at 5 and 10-years postoperatively compared to Mayo PFS alone.
Elevated RISK groups were independently associated with poor DFS and OS among patients with non-metastatic RCC, demonstrating discrimination comparable to established models. Pending validation, the addition of RISK to existing models may enhance prognostication and counselling.

PMID:
42296303
Bibliographic data and abstract were imported from PubMed on 16 Jun 2026.

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