{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:06:43Z","timestamp":1787677603472,"version":"build-2784847793"},"reference-count":29,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The Meet-URO score combines the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria with neutrophil-to-lymphocyte ratio (NLR) and bone metastasis status. Although developed in immune checkpoint inhibitor (ICI) cohorts, its performance among patients receiving first-line tyrosine kinase inhibitor (TKI) monotherapy is uncertain. Methods: We performed a multicenter, retrospective cohort study of 301 adults with histologically confirmed metastatic renal cell carcinoma (mRCC) treated with first-line TKI monotherapy (sunitinib, pazopanib, or cabozantinib) between 2008 and 2025 across five tertiary centers in Turkey. The primary endpoint was overall survival (OS). Meet-URO was calculated at treatment start and analyzed as prespecified risk strata (0\u20134, 5\u20138, 9). Kaplan\u2013Meier estimates, Cox models, and Harrell\u2019s C-index assessed discrimination, with bootstrapped 95% CIs. Results: Median follow-up was 40 months; median OS (mOS) was 25 months (95% CI, 21\u201329) and median progression-free survival was 10 months (95% CI, 8\u201312). Meet-URO stratified OS: 41 months for scores 0\u20134, 21 months for 5\u20138, and 7 months for 9 (log-rank p &lt; 0.001). In multivariable analysis, Meet-URO remained independently prognostic (HR 1.73 for 5\u20138 vs. 0\u20134; HR 3.57 for 9 vs. 0\u20134; both p &lt; 0.001). Discrimination was modest (C-index 0.722) and slightly lower than IMDC (C-index 0.745). NLR \u2265 3.2 was associated with inferior OS (19 vs. 37 months; p &lt; 0.001). Bone metastasis was not significantly associated with OS (p = 0.27). Conclusions: Meet-URO is a valid prognostic tool for mRCC patients treated with first-line TKIs and identifies an ultra-high-risk subgroup (score = 9) with poor survival. While not superior to IMDC, Meet-URO may offer complementary risk information to support clinical monitoring and trial referral, particularly in settings where ICI combinations are restricted.<\/jats:p>","DOI":"10.3390\/jcm14186385","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T12:04:55Z","timestamp":1757505895000},"page":"6385","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluation of the Meet-URO Score in a Real-World Cohort of mRCC Patients Treated with First-Line TKIs"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2863-3243","authenticated-orcid":false,"given":"Faruk Recep","family":"\u00d6zalp","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Dokuz Eylul University Faculty of Medicine, Izmir 35340, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7753-1482","authenticated-orcid":false,"given":"Ece","family":"\u015eahin Haf\u0131zo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Celal Bayar University Faculty of Medicine, Manisa 45030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6126-4611","authenticated-orcid":false,"given":"Ahmet Melih","family":"Arslan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dokuz Eylul University Faculty of Medicine, Izmir 35340, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet","family":"\u00c7akmak","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Bilkent City Hospital, Ankara 06800, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1053-0668","authenticated-orcid":false,"given":"Sedat","family":"Biter","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, \u00c7ukurova University Faculty of Medicine, Adana 01250, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9046-1772","authenticated-orcid":false,"given":"Rezan Berkay","family":"\u0130zg\u00f6r","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Dokuz Eylul University Faculty of Medicine, Izmir 35340, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oktay Halit","family":"Aktepe","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dokuz Eylul University Faculty of Medicine, Izmir 35340, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9317-942X","authenticated-orcid":false,"given":"Ferhat","family":"Ekinci","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Celal Bayar University Faculty of Medicine, Manisa 45030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7083-8517","authenticated-orcid":false,"given":"H\u00fcseyin Salih","family":"Semiz","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dokuz Eylul University Faculty of Medicine, Izmir 35340, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130smail O\u011fuz","family":"Kara","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, \u00c7ukurova University Faculty of Medicine, Adana 01250, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Erman","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u015euayib","family":"Yal\u00e7\u0131n","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aziz","family":"Karao\u011flu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dokuz Eylul University Faculty of Medicine, Izmir 35340, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s00262-023-03621-1","article-title":"Updated systematic review and network meta-analysis of first-line treatments for metastatic renal cell carcinoma with extended follow-up data","volume":"73","author":"Yanagisawa","year":"2024","journal-title":"Cancer Immunol. Immunother."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1056\/NEJMoa1510665","article-title":"Nivolumab versus Everolimus in Advanced Renal-Cell Carcinoma","volume":"373","author":"Motzer","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1056\/NEJMoa1712126","article-title":"Nivolumab plus Ipilimumab versus Sunitinib in Advanced Renal-Cell Carcinoma","volume":"378","author":"Motzer","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.euros.2022.12.015","article-title":"Real-world Treatment Patterns and Clinical Outcomes for Metastatic Renal Cell Carcinoma in the Current Treatment Era","volume":"49","author":"Shah","year":"2023","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4528","DOI":"10.1200\/JCO.2024.42.16_suppl.4528","article-title":"Comparison of TKI and CPI strategies as first-line treatment of patients with advanced renal cell carcinoma: Real-world outcome data from the German research platform CARAT","volume":"42","author":"Goebell","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Castro, D.V., Gebrael, G., Meza, L., Li, X., Tripathi, N., Tandar, C., Sayegh, N., Zengin, Z.B., Chehrazi-Raffle, A., and Govindarajan, A. (2025). Impact of insurance status on survival outcomes in patients with metastatic renal cell carcinoma. JCO Oncol. Adv., 2.","DOI":"10.1200\/OA.24.00015"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.eururo.2024.10.019","article-title":"First and Second-line Treatments in Metastatic Renal Cell Carcinoma","volume":"87","author":"Saad","year":"2025","journal-title":"Eur. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"5794","DOI":"10.1200\/JCO.2008.21.4809","article-title":"Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: Results from a large, multicenter study","volume":"27","author":"Heng","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"17588359211019642","DOI":"10.1177\/17588359211019642","article-title":"Inflammatory indices and clinical factors in metastatic renal cell carcinoma patients treated with nivolumab: The development of a novel prognostic score (Meet-URO 15 study)","volume":"13","author":"Rebuzzi","year":"2021","journal-title":"Ther. Adv. Med. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100634","DOI":"10.1016\/j.esmoop.2022.100634","article-title":"Validation of the Meet-URO score in patients with metastatic renal cell carcinoma receiving first-line nivolumab and ipilimumab in the Italian Expanded Access Program","volume":"7","author":"Rebuzzi","year":"2022","journal-title":"ESMO Open"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.clgc.2023.10.001","article-title":"Prognostic Stratification by the Meet-URO Score in Real-World Older Patients With Metastatic Renal Cell Carcinoma (mRCC) Receiving Cabozantinib: A Subanalysis of the Prospective ZEBRA Study (Meet-URO 9)","volume":"22","author":"Damassi","year":"2024","journal-title":"Clin. Genitourin. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Bimbatti, D., Pierantoni, F., Lai, E., Ballestrin, M., Cavasin, N., Erbetta, E., De Toni, C., Basso, U., and Maruzzo, M. (2023). Advanced Non-Clear Cell Renal Cell Carcinoma Treatments and Survival: A Real-World Single-Centre Experience. Cancers, 15.","DOI":"10.3390\/cancers15174353"},{"key":"ref_13","unstructured":"Ghose, A., Signori, A., Brown, N., Haywood, S., Tapia, J., Vijay, A., Cheung, M., Mahajan, I., Fiala, O., and Abrol, R. (2025, August 03). External validation of the novel prognostic Meet-URO score in Metastatic Renal Cell Carcinoma on First Line Immune-combination therapy [IUC20761-50], Int. Urol. Cancer Summit, Available online: https:\/\/urologycancersummit.org\/external-validation-of-the-novel-prognostic-meet-uro-score-in-metastatic-renal-cell-carcinoma-on-first-line-immune-combination-therapy\/."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e16516","DOI":"10.1200\/JCO.2024.42.16_suppl.e16516","article-title":"The prognostic value of Meet-URO score in patients with metastatic clear cell renal cell carcinoma receiving second or third-line tyrosine kinase inhibitors\/immune checkpoint inhibitors combination therapy: A real-world study","volume":"42","author":"He","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1016\/j.annonc.2024.05.537","article-title":"Renal cell carcinoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up","volume":"35","author":"Powles","year":"2024","journal-title":"Ann. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/j.eururo.2025.02.020","article-title":"European association of urology guidelines on renal cell carcinoma: The 2025 update","volume":"87","author":"Bex","year":"2025","journal-title":"Eur. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"17588359221079580","DOI":"10.1177\/17588359221079580","article-title":"Application of the Meet-URO score to metastatic renal cell carcinoma patients treated with second- and third-line cabozantinib","volume":"14","author":"Rebuzzi","year":"2022","journal-title":"Ther. Adv. Med. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Murianni, V., Signori, A., Buti, S., Rebuzzi, S.E., Bimbatti, D., De Giorgi, U., Chiellino, S., Galli, L., Zucali, P.A., and Masini, C. (2024). Time to strategy failure and treatment beyond progression in pretreated metastatic renal cell carcinoma patients receiving nivolumab: Post-hoc analysis of the Meet-URO 15 study. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1307635"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"102792","DOI":"10.1016\/j.ctrv.2024.102792","article-title":"Implications of bone metastasis on response to systemic therapy in patients with advanced renal cell carcinoma: A systematic literature review","volume":"129","author":"Brown","year":"2024","journal-title":"Cancer Treat. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s00262-024-03897-x","article-title":"First-line immune-based combinations or sunitinib in favorable-risk metastatic renal cell carcinoma: A real-world retrospective comparison from the ARON-1 study","volume":"74","author":"Roviello","year":"2025","journal-title":"Cancer Immunol. Immunother."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/CAD.0000000000000883","article-title":"A metanalysis on cabozantinib and bone metastases: True story or commercial gimmick?","volume":"31","author":"Bersanelli","year":"2020","journal-title":"Anti-Cancer Drugs"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"7202","DOI":"10.7150\/jca.48062","article-title":"Prognostic Impact of Bone Metastasis on Survival Outcomes in Patients with Metastatic Renal Cell Carcinoma Treated by First Line Tyrosine Kinase Inhibitors: A Propensity-Score Matching Analysis","volume":"11","author":"Kang","year":"2020","journal-title":"J. Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"231","DOI":"10.3892\/ol.2025.14977","article-title":"Prognostic value of the neutrophil-to-lymphocyte ratio in renal cell carcinoma: A systematic review and meta-analysis","volume":"29","author":"Lou","year":"2025","journal-title":"Oncol. Lett."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"102072","DOI":"10.1016\/j.clgc.2024.102072","article-title":"NLR Outperforms Low Hemoglobin and High Platelet Count as Predictive and Prognostic Biomarker in Metastatic Renal Cell Carcinoma Treated with Immune Checkpoint Inhibitors","volume":"22","author":"Young","year":"2024","journal-title":"Clin. Genitourin. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Angulo, J.C., Larrinaga, G., Lecumberri, D., Iturregui, A.M., Solano-Iturri, J.D., Lawrie, C.H., Armesto, M., Dorado, J.F., Nunes-Xavier, C.E., and Pulido, R. (2024). Predicting Survival of Metastatic Clear Cell Renal Cell Cancer Treated with VEGFR-TKI-Based Sequential Therapy. Cancers, 16.","DOI":"10.20944\/preprints202407.2128.v1"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"4100","DOI":"10.1002\/cam4.5268","article-title":"Clinical impact of early response to first-line VEGFR-TKI in patients with metastatic renal cell carcinoma on survival: A multi-institutional retrospective study","volume":"12","author":"Sobu","year":"2023","journal-title":"Cancer Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Rebuzzi, S.E., Fornarini, G., Signori, A., Buti, S., Procopio, G., De Giorgi, U., Pignata, S., Naglieri, E., Maruzzo, M., and Banna, G.L. (2024). International multicenter real-world REGistry for patients with metastatic renAL cell carcinoma\u2014Meet-URO 33 study (REGAL study). BMC Cancer, 24.","DOI":"10.1186\/s12885-024-12319-1"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"\u00d6zalp, F.R., Y\u00f6r\u00fcko\u011flu, K., Y\u0131ld\u0131r\u0131m, E.\u00c7., Uzun, M., and Semiz, H.S. (2024). Prognostic value of B7-H3 expression in metastatic renal cell carcinoma and its impact on immunotherapy response. BMC Cancer, 24.","DOI":"10.1186\/s12885-024-13238-x"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.ccell.2020.10.011","article-title":"Molecular subsets in renal cancer determine outcome to checkpoint and angiogenesis blockade","volume":"38","author":"Motzer","year":"2020","journal-title":"Cancer Cell"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6385\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:43:14Z","timestamp":1760035394000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,10]]},"references-count":29,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14186385"],"URL":"https:\/\/doi.org\/10.3390\/jcm14186385","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,10]]}}}