In the most advanced stage of the disease, the RCCmets compared to pT3-4 stage showed an up-regulation of genes (FASN, PFKM, PLD1, AKT2, Citrate synthase (CS) and MDH2) that are associated with aggressive cell proliferation, migration, apoptosis, lipid droplet formation and regulate metabolic disorders of the ccRCC microenvironment. Here, MDH2 is linked to nonpapillary renal cell carcinoma.