Active surveillance (AS) may be used effectively in a subgroup of patients(pts) with metastatic renal cell carcinoma (RCC) and indolent disease to postpone the commencement of systemic treatment without affecting long-term survival. However, an absence of research on criteria that predicted positive outcomes has hampered AS’s broader acceptance. A study was conducted to characterize patients receiving AS at an extensive academic medical facility to identify characteristics linked to the duration spent on AS. Researchers used Kidney Cancer Explorer (KCE), the UT Southwestern Medical Center’s Kidney Cancer Program (2005-2020), and feedback from clinical oncologists to find pts on AS. The AS cohort was characterized by two factors: (1) having metastatic RCC (defined as a suspicious lesion > 1cm or a positive biopsy) and (2) not having had prior systemic treatment. At the outset, baseline parameters and IMDC guidelines were assessed. Progression-free survival (PFS), time to systemic therapy (TST), and overall survival (OS) were all essential outcomes. Kaplan Meier techniques were used to calculate survival predictions. In univariate and multivariate analyses, Cox proportional hazard models were utilized to discover baseline features linked to TST. Researchers found 37 pts with metastatic RCC who were undergoing AS; 31 pts (83.8%) had ccRCC, 28 pts (75.7%) had an excellent IMDC prognostic category, 18 patients (48.6%) had one metastatic lesion at baseline, and the cohort’s average tumor burden was 21mm. Most pts progressed clinically or radiologically, with a median PFS of 10.8 months (95 % CI: 8.13-23.31). TST was 37 months on average (95% CI: 24.3-94.9). There were 11 fatalities in total (none of which happened before the start of systemic therapy), and the median OS after starting AS was 132.5 months (95 % CI: 87.3-NR). According to Multivariate analysis, more significant numbers of metastatic lesions at baseline were linked with a shorter TST (HR:1.45; 95% CI: 1.03-2.03, p = 0.03). At a median follow-up of 62.5 months, patients had not begun systemic medication, 11/37 (29%). These outcomes were built on prior research and suggested that AS might be used to postpone systemic therapy in some pts with metastatic RCC.