Background: Challenges remain in determining the most effective treatment strategies and identifying patients who would benefit from adjuvant or neoadjuvant therapy in renal cell carcinoma. The objective of this review is to provide a comprehensive overview of biomarkers in metastatic renal cell carcinoma (mRCC) and their utility in prediction of treatment response, prognosis, and therapeutic monitoring in patients receiving systemic therapy for metastatic disease. Methods: A systematic literature search was conducted using the PubMed database for relevant studies published between January 2017 and December 2022. The search focused on biomarkers associated with mRCC and their relationship to immune checkpoint inhibitors, targeted therapy, and VEGF inhibitors in the adjuvant, neoadjuvant, and metastatic settings. Results: The review identified various biomarkers with predictive, prognostic, and therapeutic monitoring potential in mRCC. The review also discussed the challenges associated with anti-angiogenic and immune-checkpoint monotherapy trials and highlighted the need for personalized therapy based on molecular signatures. Conclusion: This comprehensive review provides valuable insights into the landscape of biomarkers in mRCC and their potential applications in prediction of treatment response, prognosis, and therapeutic monitoring. The findings underscore the importance of incorporating biomarker assessment into clinical practice to guide treatment decisions and improve patient outcomes in mRCC.

The role of musculoskeletal metrics on the incidence of radiologic parastomal hernia (PSH) following cystectomy and ileal conduit (IC) urinary diversion is not well understood. We retrospectively reviewed the clinical data and preoperative CT scans of patients from the Prophylactic Use of Biologic Mesh in Ileal Conduit (PUBMIC) trial (#NCT02439060) to assess the relationship between sarcopenia and body fat metrics on the incidence of radiologic PSH following cystectomy and IC urinary diversion. We used Synapse 3D (Fujifilm, Stamford, CT) in a semiautomated fashion to extract visceral fat area (VFA), subcutaneous fat area (SFA), and waist circumference (WC) from CT scans at the levels of upper L3 and umbilicus. The psoas muscle was automatically measured at the level of L3 to assess sarcopenia via the lowest sex-specific quartile of the psoas muscle index (PMI: PMA/Ht ² ). 137 patients’ data were eligible to be analyzed from the PUBMIC trial for this study. Multivariable analysis indicated that SFA at the level of L3>220cm ² (Q3) was significantly associated with an increased risk of PSH (HR: 2.5, 95% CI 1.2-5.2; P=0.01). No other significant associations between PSH development and other clinical and radiologic features were discovered. Nevertheless, utilizing Synapse 3D in a semiautomated fashion offers a method to investigate other radiologic factors that may impact the development of PSH and other oncological and non-oncological patient outcomes.