Metastatic renal cell carcinoma (mRCC) comprises a highly heterogeneous group of diseases with varied clinical outcomes. As a result, models to estimate prognosis were developed in an attempt to aid patient counseling, treatment selection, and clinical trial design. Contemporary prognostic models have been mostly generated based on clinical factors because of their ease of use. Recent advances in molecular techniques have allowed unprecedented molecular profiling of RCC and the discovery of genomic and proteotranscriptomic factors that may contribute to disease trajectory. With the advent of multiple systemic therapies in mRCC in recent years, predictive biomarkers have become increasingly relevant in treatment selection. In this review, we discuss the existing staging systems and prognostic models in mRCC. We also highlight various promising molecular biomarkers according to the subtypes of RCC and explore their integration into the traditional prognostic models. In addition, we discuss emerging predictive biomarkers in the era of immuno-oncology. Lastly, we explore future directions with a focus on liquid biopsies and composite biomarkers.

转移性肾细胞癌(mRCC) 包括一组高度异质性的疾病，具有不同的临床结果。因此，为了帮助患者咨询、治疗选择和临床试验设计，开发了估计预后的模型。现代预后模型大多是基于临床因素生成的，因为它们易于使用。分子技术的最新进展允许对 RCC 进行前所未有的分子分析，并发现可能有助于疾病轨迹的基因组和蛋白质转录组学因素。近年来，随着 mRCC 中多种全身疗法的出现，预测性生物标志物在治疗选择中变得越来越重要。在这篇综述中，我们讨论了 mRCC 中现有的分期系统和预后模型。我们还根据 RCC 的亚型重点介绍了各种有前景的分子生物标志物，并探索它们与传统预后模型的整合。此外，我们还讨论了免疫肿瘤学时代新兴的预测性生物标志物。最后，我们探索未来的方向，重点是液体活检和复合生物标志物。