A prognostic nomogram predicts survival in metastatic renal cell carcinoma using SEER data from 2016 to 2022

Abstract Research on the prognosis of patients with metastatic renal cell carcinoma (mRCC) in the contemporary period (2016–2022) remains limited. This study aimed to construct a prognostic nomogram for mRCC patients and identify key clinical factors influencing their prognosis. Univariate and multivariate Cox regression analyses were performed to determine independent risk factors, which were subsequently used to construct the prognostic nomogram. The nomogram’s performance was comprehensively assessed using the C-index, area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). The SHapley Additive exPlanations (SHAP) method was applied to rank the importance of features influencing 6-month, 1-year, 2-year, and 3-year overall survival (OS). In addition, propensity score matching (PSM) and Kaplan-Meier survival analysis were conducted to compare survival outcomes between patients who did and did not receive surgery. The nomogram demonstrated acceptable discriminative performance with good calibration, as evidenced by the C‑index, AUC, calibration curves, and DCA. SHAP analysis revealed that surgery was the most important factor at all evaluated time points. Furthermore, after PSM balancing, patients who underwent surgery had a 39% reduction in the risk of death (OS) (HR 0.61; 95% CI 0.49–0.75; p < 0.001) and a 41% reduction in the risk of cancer‑specific mortality (CSS; HR 0.59; 95% CI 0.48–0.74; p < 0.001). Subgroup analysis demonstrated that surgery conferred a survival benefit in patients with bone and lung metastases, whereas no significant benefit was observed in those with brain or liver metastases. In conclusion, we constructed a prognostic nomogram for mRCC patients, providing a proof-of-concept framework for post-treatment risk stratification, prognostic counseling, and individualized follow-up planning. Our findings also indicate that surgical intervention is significantly associated with superior survival outcomes in selected patients.