The purpose of this study was to explore independent favorable prognostic factors for predicting 1-, 3-, and 5-year overall survival (OS) and cancer-specific survival (CSS) in patients with stage Ⅳ cell renal cell carcinoma (RCC) by constructing nomograms.

A total of 2636 patients diagnosed with stage Ⅳ RCC from 2010 to 2015 were enrolled in the surveillance, epidemiology, and end results database. Multivariate Cox hazard regression and competing risk analysis were used for searching prognosis factors in the cohort. The nomograms were constructed for predicting 1-, 3-, and 5-year of OS and CSS. Concordance index (C-index) and the calibration curves were used to evaluate the discrimination and accuracy of the nomograms.

Age, nephrectomy, histology, N stage, and brain/liver/lung metastasis were identified as independent favorable prognostic factors in OS and CSS via univariate and multivariate analyses. Other variables were further selected by clinical practice and net reclassification improvement (NRI). Finally, age, nephrectomy, histology, grade, tumor size, T stage, N stage, and bone/brain/liver/lung metastasis were chosen to construct nomograms. The C-index of the OS and CSS in nomograms were 0.697 (95% confidence interval (CI), 0.683–0.711) and 0.655 (95% CI, 0.639–0.671), respectively. The calibration curves revealed high consistency between the nomograms prediction and actual observation.

The nomograms may help clinicians to conveniently predict the survival of RCC patients with stage Ⅳ and provide guidance in choosing the suitable management.