Assure Renal Cell Carcinoma (RCC) Prognosis

Use results in combination with the complete clinical picture and specialist expertise to inform, not dictate, goals-of-care discussions and management decisions, including:

• Adjuvant therapies.
• Surveillance imaging and frequency.
• Clinical trial eligibility.
• Comorbidity management.

• Low predicted risk (DFS/OS): Routine guideline-based surveillance imaging (e.g., per NCCN schedule); adjuvant systemic therapy is generally not indicated.

• Intermediate predicted risk: Consider more frequent surveillance imaging and discuss clinical trial enrollment, given uncertain benefit of standard adjuvant therapy in this group.

• High predicted risk (DFS/OS) or high-risk EDP classification:

  • Consider referral for discussion of adjuvant systemic therapy (e.g., adjuvant pembrolizumab per KEYNOTE-564 in eligible patients) or enrollment in an adjuvant/neoadjuvant clinical trial, and intensify surveillance imaging (e.g., every 3–6 months) given the elevated risk of early recurrence.

  • Use the high-risk EDP classification specifically to identify patients who warrant the earliest and most intensive surveillance interval within the first postoperative year.

• Do not apply before final surgical pathology is available; the score requires complete resection with central/final staging and cannot substitute for preoperative clinical or imaging-based staging.

• Do not use in metastatic disease at presentation or in low-risk tumors (pT1a any grade, pT1b grade 1–2); the model was not derived or validated in these populations.

• This is a prognostic, not predictive, tool; an elevated score identifies patients at higher risk of recurrence or death but does not itself establish that adjuvant therapy will improve outcomes for a given patient.

• Interpret long-term (5–10 year) risk estimates cautiously given the model's demonstrated time-dependent loss of discrimination; short-term (1–2 year) estimates are more reliable.