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tructural basis for the progressive learning and memory dysfunctions seen in Alzheimer's disease cases. Studies assessing outcome improvements over a long period according to systemic therapy strategies for metastatic renal cell carcinoma using real-world data, including the results of the recent era of immune checkpoint inhibitors, are limited. Herein, we retrospectively evaluated patients who were diagnosed with metastatic renal cell carcinoma over a 40-year span. Patients were classified into four groups based on when their metastas