MDCalc

IMDC (International Metastatic RCC Database Consortium) Risk Model for Metastatic Renal Cell Carcinoma

Predicts survival in patients with metastatic renal cell carcinoma treated with systemic therapy (also known as Heng criteria).

  • Use baseline factors at the start date of the current line of systemic therapy, except for the “time of diagnosis to systemic therapy” criterion, which is always relative to first-line therapy.

  • Use limits of normal set by the laboratory performing the tests (for hemoglobin concentration, absolute neutrophil count, platelet count, corrected calcium concentration).

  • Always correct calcium concentration for low albumin before scoring.

<1 year from time of diagnosis to systemic therapy
Karnofsky Performance Status <80%
Hemoglobin < lower limit of normal
Usually ~120 g/L or 12 g/dL
Corrected calcium > upper limit of normal
Usually ~8.5-10.2 mg/dL
Neutrophils > upper limit of normal
Usually ~2.0-7.0×10⁹/L
Platelets > upper limit of normal
Usually ~150,000-400,000 cells/µL

Result:

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Management

According to NCCN guidelines (v3.2019), choice of first-line systemic therapy for metastatic renal cell carcinoma based on risk group is:

  • Intermediate or poor risk: ipilimumab plus nivolumab (Phase III trial evidence) or cabozantinib (Phase II trial evidence). 

  • Favorable risk: PAZOPanib or SUNItinib.

Refer to AUA guidelines for further details on management of renal cancer.

Critical Actions

Can only be applied to patients with metastatic renal cell carcinoma that receive systemic therapy.

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