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Kidney Cancer · Diagnosis & Tests
IMDC risk groups explained — favourable, intermediate and poor risk in advanced kidney cancer
If your kidney cancer has spread, somewhere in your notes there will be a short phrase — favourable risk, intermediate risk or poor risk. That is your IMDC risk group, and it is not a second staging system. It is a count. Six routine findings are checked when systemic treatment is about to start, and how many of them are present decides the group. Five come from a blood test and a date; the sixth is how you are managing day to day. This page explains what each of the six is, how the IMDC score for kidney cancer is arrived at, and what the group does and does not decide about your treatment.
- It is a count, not a scan finding — Six items are checked and simply added up. Nothing is measured on imaging, and nothing new has to be done to you to work it out.
- Three groups, set by how many factors are present — None of the six means favourable risk. One or two means intermediate. Three or more means poor risk.
- Only for advanced disease — The score exists to help plan systemic treatment. If your cancer is still confined to the kidney, no IMDC group will appear in your notes, and that is correct.
- Worked out in-house at CION — The blood tests and the clinical assessment behind the score, and the systemic treatment it informs, are delivered by our medical oncology team. Surgery and PET-CT are coordinated with specialist partners.
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What is actually counted
The six findings behind an IMDC risk group
IMDC is short for the International Metastatic RCC Database Consortium — the group of centres whose pooled records the model was built from. Each of the six items below is either present or not present. Nothing is weighted, and nothing is scored out of ten. If you are still working out what advanced disease itself means, start with stage 4 (metastatic) kidney cancer — what it means; the broader picture is on our kidney cancer guide.
How you are managing day to day
The first item is performance status — a plain measure of how much of ordinary life you are still doing without help. On the Karnofsky scale, a score below 80 counts as a risk factor. That threshold roughly marks the point where normal activity takes effort or needs occasional assistance. It is judged in the consulting room, by conversation and examination, not by a machine, which is one reason it is worth being frank about a bad week rather than putting a brave face on it.
How long since the diagnosis
The second item is a date, not a test. If less than one year has passed between the kidney cancer being diagnosed and the day systemic treatment begins, that counts as a factor. The reasoning is simple: disease that needs treating soon after it is found is usually behaving more actively than disease that has been quietly watched for years. It is the only one of the six that can never change once it is set, because it is a fact about the calendar.
Haemoglobin below the normal range
Anaemia counts as a factor. Kidney cancer can cause it in more than one way — through blood loss in the urine, through the effect of ongoing inflammation on the bone marrow, or through reduced production of the hormone that tells the marrow to make red cells. It is read off a full blood count, against your own laboratory's reference range for your sex. Anaemia is also treatable in its own right, and treating it usually makes you feel better regardless of what the score says.
Corrected calcium above the normal range
A raised calcium counts as a factor. The word corrected matters: calcium travels in the blood partly bound to albumin, so the laboratory adjusts the raw figure for your albumin level before it is judged high or low. A high corrected calcium can make you thirsty, constipated, drowsy or confused, and it is one of the findings that is acted on quickly in its own right rather than simply recorded. Tell your team about new confusion or drowsiness the same day.
Neutrophil count above the normal range
Neutrophils are the commonest white blood cell. A count above the upper limit of normal counts as a factor. Here it is not being read as a sign of infection; it is read as a marker of the inflammatory state that active cancer can drive. It comes from the same full blood count as the haemoglobin, at no extra cost and with no extra needle. If you have an infection or have recently taken steroids, say so, because both can lift the count for reasons that have nothing to do with the cancer.
Platelet count above the normal range
The sixth item is a platelet count above the upper limit of normal, and it is read the same way as the neutrophils — as a marker of an active inflammatory state rather than as a bleeding or clotting problem in itself. Four of the six factors therefore come from two ordinary tubes of blood, which is why the whole score can usually be worked out at the first consultation. All of this bloodwork is done in-house at CION. Book a free consultation if nobody has yet gone through yours with you.
A risk group is not a stage, and it is not a prediction about you.
Stage describes where the cancer has reached. Grade describes how the cells look. The IMDC group describes how the disease and your body are behaving on one particular day, and it exists to help a team choose between treatment approaches. It was built by looking back at what happened to large numbers of people — so it describes a pattern across a population, not a path laid out for one person.
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Favourable, intermediate, poor
What each IMDC risk group means
Read this to understand the phrase in your notes, not to score yourself. Reference ranges differ between laboratories, performance status is a clinical judgement, and the count is made on a specific day with a specific set of results.
| Risk group | How many of the six factors | What it means in practice |
|---|---|---|
| Favourable | None of the six is present. | Blood counts, calcium and performance status are all in the ordinary range, and more than a year passed between diagnosis and the start of systemic treatment. The disease is behaving less aggressively, and there is usually more room to weigh the options unhurriedly. |
| Intermediate | One or two are present. | The commonest group. It tells the team that something is active without saying the situation is urgent. Which one or two factors are present matters as much as the count, because some of them are directly treatable. |
| Poor | Three or more are present. | The disease is behaving actively and treatment should not be delayed. It is not a statement that treatment will fail. Several recommended systemic options are aimed specifically at intermediate and poor risk disease. |
What the group changes most often is which class of systemic treatment is put forward first — combination immunotherapy, a PD-1 inhibitor paired with a VEGF-targeted drug, or a targeted tablet on its own. How those classes work is set out on immunotherapy for advanced kidney cancer, and the named regimens and costs are on our kidney cancer treatment in Hyderabad page.
The fine print
Six things the risk group does not say out loud
These are the details most often skipped when a risk group is mentioned in passing. None of them are technicalities — each one changes how the phrase should be read.
Timing
It is a snapshot of one particular day
The score is worked out at the point systemic treatment is about to start, from the results available then. It is not recalculated week by week, and it is not a running measure of how you are doing. If your treatment plan is being revisited months later, it is reasonable to ask whether the group was worked out again from current bloods, or simply carried over from the first set.
Two models
IMDC and MSKCC are not the same score
An older model from MSKCC sorts patients into the same three groups but uses a slightly different list, including a lactate dehydrogenase level. It was built before targeted and immune-based treatment existed. IMDC came from patients treated in the modern era and uses the neutrophil and platelet counts instead. Most current guidance is written around IMDC, so check which one a number in your notes refers to.
Treatable factors
Some of the six can be corrected
Anaemia, a raised calcium and poor performance status caused by uncontrolled symptoms are all treatable in their own right, and treating them is part of the plan rather than a way of gaming the score. The group recorded in your notes stays as it was, but how you feel, and what you are able to tolerate, can genuinely improve within weeks.
Not for early disease
It says nothing about localised kidney cancer
The model was built for cancer that has already spread and is applied when systemic therapy is being planned. For disease still confined to the kidney, the conversation is about stage, grade and the surgical plan, and different tools are used to judge the chance of recurrence. A missing risk group on an early-stage report is not an omission.
Surgery question
It feeds into whether the kidney is removed at all
When cancer has already spread, removing the primary tumour is a considered decision rather than an automatic one, and risk group is one of the things weighed. At CION that surgery, along with PET-CT, is coordinated with specialist urology, uro-oncology and interventional radiology partners, where it may also be billed. The systemic treatment and radiation around it are delivered in-house by our own team.
Second opinion
The count is worth checking
A single borderline result can move a group from favourable to intermediate, and reference ranges are not identical between laboratories. Where the group looks out of step with how you actually are, asking for the six factors to be gone through item by item is reasonable and routine. At CION that review is part of a free second opinion, before any plan is settled.
Where the risk group sits in the whole plan. It is one input among several. The stage, the tumour type on pathology, your kidney function, other medical conditions and your own priorities all sit beside it, and every case at CION goes to a tumour board rather than to one doctor's opinion. The plan is then built along NCCN lines, with immunotherapy, combination immunotherapy, VEGF-targeted and mTOR-directed therapy, and radiation delivered in-house by our medical oncology team, while nephrectomy, ablation and PET-CT are coordinated with specialist urology, uro-oncology and interventional radiology partners. The full route, including what each part costs, is on our kidney cancer treatment in Hyderabad page, explained in writing before anything begins.
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Common questions
Questions people ask about IMDC risk groups
What are the IMDC risk groups for kidney cancer?
IMDC stands for the International Metastatic RCC Database Consortium. It is a way of sorting advanced kidney cancer into three groups - favourable, intermediate and poor risk - by counting how many of six routine findings are present when systemic treatment is about to start. Five of the six come from blood tests and from the date of your diagnosis. The sixth is how well you are managing day to day. None of the six present means favourable risk, one or two means intermediate risk, and three or more means poor risk. The group is a planning tool that oncology teams use alongside NCCN guidance when choosing the first line of treatment. It describes a pattern seen across many patients, not a promise about any one person.
What are the six IMDC risk factors?
They are: a performance status below 80 on the Karnofsky scale, meaning you need some help with ordinary daily activity; less than one year between the kidney cancer diagnosis and the day systemic treatment begins; a haemoglobin below your laboratory's normal range, which is anaemia; a corrected calcium above the normal range; a neutrophil count above the normal range; and a platelet count above the normal range. Four of the six are read straight off a full blood count and a routine biochemistry panel, which is why the score can usually be worked out at the first consultation without any extra test. Because each laboratory sets its own reference range, the same raw number can be scored differently in two different labs.
What is the difference between the IMDC and MSKCC risk scores?
Both sort advanced kidney cancer into favourable, intermediate and poor risk, and they share several factors. The older MSKCC model was built in the era before targeted and immune-based treatment, and it used a lactate dehydrogenase level as one of its measures. The IMDC model came later, from patients treated in the targeted-therapy era, and it uses the neutrophil and platelet counts instead. Because systemic treatment for kidney cancer today is targeted or immune-based, IMDC is the model most teams work with and the one most current guidance is written around. If your notes mention both, they are answering the same question with information gathered in two different periods.
Does a poor-risk IMDC score mean treatment will not work?
No. Poor risk means three or more of the six factors were present on the day the score was worked out. It says the disease is behaving actively and that treatment should not be delayed. It does not say treatment will fail. The risk group is used mainly to help choose between approaches - combination immunotherapy, a PD-1 inhibitor paired with a VEGF-targeted drug, or a targeted tablet on its own - and some of those options are recommended specifically for intermediate and poor risk disease. Several of the six factors, such as anaemia or a raised calcium, can also be treated in their own right. Your oncologist reads the score as the start of a conversation, not as a verdict.
Can my IMDC risk group change over time?
The score is normally recorded once, at the point systemic treatment is about to begin, and that recorded group is the one referred to afterwards. The findings behind it are not fixed, though. Anaemia can be corrected, a raised calcium can be brought down, and performance status often improves once symptoms are properly controlled. If treatment has to be changed later, many teams work the score out again using that day's results, because the picture has moved on. So it is entirely fair to ask which set of blood tests your risk group was based on, and when they were taken. Results from several months ago should not be quietly carried forward.
Is the IMDC score used for early-stage kidney cancer?
No. It was built for kidney cancer that has already spread, and it is applied at the point systemic therapy is being planned. If your cancer is still confined to the kidney, your team will be discussing stage, grade and the surgical plan instead, and no IMDC group will appear in your notes. Other tools are used to judge the chance of the cancer returning after surgery. If you have been told the disease is advanced and no risk group has been recorded, that is worth raising before systemic treatment starts, because current guidance leans on it when the first line of treatment is chosen.
This page is general health information about how the IMDC risk model works. It is not a diagnosis, it is not a prognosis, and it cannot replace a specialist review of your own blood results, scans and reports. Only a doctor who has seen your results and examined you can say which group you are in and what it means for your plan. If you have been told your kidney cancer is advanced, please arrange a review rather than waiting — and tell your team the same day about new confusion or drowsiness, new bone pain, breathlessness or blood in the urine, because those symptoms change what is looked at next.