First-Line Systemic Therapies in Advanced Renal Cell Carcinoma in Spain

Inclusion Criteria: * Age ≥18 years at the index date. * Documented diagnosis of advanced renal cell carcinoma (aRCC) identified through International Classification of Diseases (ICD) 9 codes recorded in medical history * Initiation of first-line systemic therapies within the study selection period (January 1, 2019, to December 31, 2024). * A minimum of 12 months of follow-up data available after the index date, unless the participant dies earlier. * Availability of sufficient clinical data for evaluation of primary endpoints \[overall survival (OS), progression-free survival (PFS), objective response rate (ORR), duration of response (DoR), time to response (TTR), safety). * Documented clinical follow-up at the treating center during first-line systemic therapies and at least one post-treatment initiation follow-up record. * Note: International Metastatic RCC Database Consortium (IMDC) classification is not an inclusion criterion; IMDC intermediate/poor defines the primary analysis cohort Exclusion Criteria: * Insufficient clinical information in the electronic medical records (EMR) to evaluate the study outcomes (OS, PFS, ORR, safety). * Participation in an interventional clinical trial during treatment with first-line systemic therapies that may affect clinical or safety outcomes. * Receipt of first line treatments outside routine clinical practice, such as compassionate use, expanded access, or off-label administration when relevant to the study objectives. * Diagnosis is inconsistent with advanced or metastatic RCC, including non-epithelial renal tumors or histology not aligned with the study population. * Age \<18 years at the time of first-line systemic therapies initiation. * If additional data-driven exclusions are identified during data validation, they may be described in the Statistical Analysis Plan (SAP) but will not be added as protocol-defined criteria.