{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T21:53:04Z","timestamp":1791496384715,"version":"4.3.4"},"reference-count":25,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Tumori"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Non\u2013clear cell renal cell carcinoma (nccRCC) represents a heterogeneous group of rare malignancies with limited evidence guiding systemic therapy. The recent introduction of immune checkpoint inhibitors (ICIs) and their combinations with tyrosine kinase inhibitors (TKIs) has shown promising results, but real-world data remain scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively collected clinical and pathological data from patients with metastatic nccRCC included in the Italian Meet-URO-23\/I-RARE database and from Vall d\u2019Hebron Institute of Oncology (VHIO). Prognostic factors for overall survival (OS) were analyzed using univariate and multivariate Cox regression. Treatment outcomes were assessed by histology and therapeutic regimen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 156 patients were included: papillary (56.4%), chromophobe (22.4%), translocated (10.9%), and unclassified (10.3%) RCC. Median OS was 17.5 months (95%CI 14.7\u201327.6) and median progression free survival (PFS) 10.2 months (95%CI 7.6\u201313.7). Patients treated with ICI-combinations (ICI plus ICI or ICI plus VEGF-TKI) showed significantly improved survival (median OS not reached vs 14.7 months for other regimens, p = 0.0053). The overall objective response rate (ORR) and disease free survival (DFS) for ICI+TKI was 53.3% (16\/30 evaluable) and 93.3% (28\/30), with ORR of 55.5% (10\/18) in papillary and 46.1% (6\/13) in chromophobe subtypes. In the overall ICI-combination group, ORR was 48%. In multivariate analysis, International Metastatic RCC Database Consortium (IMDC) score, presence of bone metastases, and type of first-line therapy were independently associated with OS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In this large international real-world cohort, ICI-based combinations demonstrated superior outcomes compared to other regimens in metastatic nccRCC. These results reinforce the role of immunotherapy combinations as a preferred first-line approach and confirm the IMDC score as a reliable prognostic tool in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03008916261436580","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T09:19:04Z","timestamp":1777886344000},"page":"297-304","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["International multicenter experience of prognostic factors and treatment outcomes of metastatic non-clear cell renal cell carcinoma"],"prefix":"10.1177","volume":"112","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3978-040X","authenticated-orcid":false,"given":"Alessandro","family":"Rametta","sequence":"first","affiliation":[{"name":"Genitourinary Medical Oncology, Fondazione IRCCS Istituto Nazionale dei tumori di Milano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastiano","family":"Buti","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Parma, Parma Italy"},{"name":"Oncology Unit, University Hospital of Parma, Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Stellato","sequence":"additional","affiliation":[{"name":"Genitourinary Medical Oncology, Fondazione IRCCS Istituto Nazionale dei tumori di Milano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Maruzzo","sequence":"additional","affiliation":[{"name":"Oncology 3 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Lalli","sequence":"additional","affiliation":[{"name":"Unit of Translational Immunology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Acunzo","sequence":"additional","affiliation":[{"name":"Oncology Unit, University Hospital of Parma, Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Maffezzoli","sequence":"additional","affiliation":[{"name":"Oncology Unit, University Hospital of Parma, Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Bimbatti","sequence":"additional","affiliation":[{"name":"Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Pierantoni","sequence":"additional","affiliation":[{"name":"Oncology 3 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Massari","sequence":"additional","affiliation":[{"name":"Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Ermacora","sequence":"additional","affiliation":[{"name":"Department of Oncology, Santa Maria della Misericordia Academic Hospital, Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Iacovelli","sequence":"additional","affiliation":[{"name":"Department of Oncology, Fondazione IRCCS Policlinico Universitario Agostino Gemelli, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Mennitto","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Azienda Ospedaliera Universitaria \u201cMaggiore Della Carit\u00e0\u201d, Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Mucciarini","sequence":"additional","affiliation":[{"name":"Oncology Unit, AUSL Modena, Ramazzini Hospital, Carpi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Santoni","sequence":"additional","affiliation":[{"name":"UOC Medical Oncology, Macerata Hospital, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5550-0868","authenticated-orcid":false,"given":"Lucia","family":"Fratino","sequence":"additional","affiliation":[{"name":"Medical Oncology Department, Centro di Riferimento Oncologico IRCCS, Aviano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Morales","sequence":"additional","affiliation":[{"name":"Medical Oncology, Vall d\u2019Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d\u2019Hebron, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Marmolejo","sequence":"additional","affiliation":[{"name":"Medical Oncology, Vall d\u2019Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d\u2019Hebron, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laia","family":"Catalan","sequence":"additional","affiliation":[{"name":"Medical Oncology, Vall d\u2019Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d\u2019Hebron, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Suarez","sequence":"additional","affiliation":[{"name":"Medical Oncology, Vall d\u2019Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d\u2019Hebron, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2498-402X","authenticated-orcid":false,"given":"Giuseppe","family":"Procopio","sequence":"additional","affiliation":[{"name":"Genitourinary Medical Oncology, Fondazione IRCCS Istituto Nazionale dei tumori di Milano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"Cancer Stat Facts: Kidney and Renal Pelvis Cancer - 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