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Introduction <p>The Selection for Cytoreductive Nephrectomy (SCREEN) criteria were developed to predict first-year mortality after cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) patient. SCREEN addressed several clinical difficulties from widely adopted International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model for risk prognostication. However, no external validation had been performed.</p> Methods <p>Clinical, haematological, and radiological data of consecutive synchronous mRCC patients undergoing CN at a tertiary hospital (1984–2022) were analysed. A subgroup analysis (2006–2017) was done to confirm modern relevance. Kaplan-Meier analysis, logistic regression, receiver operating characteristics (ROC) curve, calibration, and decision curve analysis (DCA) were performed for validation.</p> Results <p>Among 150 patients with synchronous mRCC who had upfront CN, SCREEN and IMDC stratified patients into favourable- (19% vs. 8%), intermediate- (58% vs. 66%) and poor-risk (23% vs. 26%) groups respectively. The first-year mortality rate was 25.3% for the entire cohort. The first-year mortality rate for SCREEN risk groups was 7.7%, 17.8% and 47.4% (<i>p</i> &lt; 0.001) while for IMDC risk groups was 8.3%, 20.3% and 33.4% respectively (<i>p</i> = 0.087). SCREEN poor-risk patients had significantly higher odds of first-year mortality risk (OR: 19.5, <i>p</i> &lt; 0.001) compared to IMDC (OR: 6.87, <i>p</i> = 0.078). SCREEN demonstrated superior discriminative ability (area under curve (AUC): 0.74 vs. 0.61, <i>p</i> &lt; 0.05). DCA showed that SCREEN provided greater clinical benefit than IMDC across mortality risk thresholds between 15% and 60%.</p> Conclusion <p>This is the first study that externally validated SCREEN criteria as a high-performing tool in an independent Asian cohort. SCREEN outperformed IMDC, especially in the poor-risk group, and identified more favourable-risk patients who may benefit from CN with minimal downgrading of patients from IMDC poor-risk group. By incorporating key radiological variables, SCREEN aids more inclusive and accurate patient selection for surgery.</p>

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SCREENing smarter: outperforming IMDC in predicting first-year mortality among patients undergoing cytoreductive nephrectomy

  • 期刊论文

  • 发表日期：

    2025年11月22日

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  • Lingyue Yu,
  • Alvin Yuanming Lee,
  • Khi Yung Fong,
  • Ee Jean Lim,
  • Yu Guang Tan,
  • Kae Jack Tay,
  • Wei Chong Tan,
  • Johan Chan,
  • Yien Ning Sophia Wong,
  • Henry Sun Sien Ho,
  • John Shyi Peng Yuen,
  • Ravindran Kanesvaran,
  • Kenneth Chen

摘要

Introduction

The Selection for Cytoreductive Nephrectomy (SCREEN) criteria were developed to predict first-year mortality after cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) patient. SCREEN addressed several clinical difficulties from widely adopted International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model for risk prognostication. However, no external validation had been performed.

Methods

Clinical, haematological, and radiological data of consecutive synchronous mRCC patients undergoing CN at a tertiary hospital (1984–2022) were analysed. A subgroup analysis (2006–2017) was done to confirm modern relevance. Kaplan-Meier analysis, logistic regression, receiver operating characteristics (ROC) curve, calibration, and decision curve analysis (DCA) were performed for validation.

Results

Among 150 patients with synchronous mRCC who had upfront CN, SCREEN and IMDC stratified patients into favourable- (19% vs. 8%), intermediate- (58% vs. 66%) and poor-risk (23% vs. 26%) groups respectively. The first-year mortality rate was 25.3% for the entire cohort. The first-year mortality rate for SCREEN risk groups was 7.7%, 17.8% and 47.4% (p < 0.001) while for IMDC risk groups was 8.3%, 20.3% and 33.4% respectively (p = 0.087). SCREEN poor-risk patients had significantly higher odds of first-year mortality risk (OR: 19.5, p < 0.001) compared to IMDC (OR: 6.87, p = 0.078). SCREEN demonstrated superior discriminative ability (area under curve (AUC): 0.74 vs. 0.61, p < 0.05). DCA showed that SCREEN provided greater clinical benefit than IMDC across mortality risk thresholds between 15% and 60%.

Conclusion

This is the first study that externally validated SCREEN criteria as a high-performing tool in an independent Asian cohort. SCREEN outperformed IMDC, especially in the poor-risk group, and identified more favourable-risk patients who may benefit from CN with minimal downgrading of patients from IMDC poor-risk group. By incorporating key radiological variables, SCREEN aids more inclusive and accurate patient selection for surgery.