The KISS can refine the current risk-stratification scheme for MDS. OS (A) and LFS (B) of patients with lower-risk IPSS-R (very low, low, and intermediate risks) MDS, stratified by the KISS. OS (C) and LFS (D) of patients with higher-risk IPSS-R (high and very high risks) MDS, stratified by the KISS. The Coxnet predictor (E) and LSC17 scores (F) were significantly higher in the KISS-high subgroup. (G) The time-dependent ROC analysis of the KISS, Coxnet, and LSC17 scores demonstrated the superior prognostic performance of KISS.