Yonsei Med J.  2008 Jun;49(3):451-458. 10.3349/ymj.2008.49.3.451.

A Comprehensive Prognostic Stratification for Patients with Metastatic Renal Clear Cell Carcinoma

• Cho KS
• Choi YD
• Kim SJ
• Kim CI
• Chung BH
• Seong DH
• Lee DH
• Cho JS
• Cho IR
• Hong SJ

• KMID: 724262
• DOI: http://doi.org/10.3349/ymj.2008.49.3.451

Abstract

PURPOSE
To develop a reliable prognostic model for patients with metastatic renal cell carcinoma (RCC) based on features readily available in common clinical settings. PATIENTS AND METHODS: A total of 197 patients with RCC who underwent nephrectomy and immunotherapy from 1995 to 2004 were retrospectively reviewed. Their mean age was 55.1+/-11.8 yrs (24-83yrs) and mean survival time from metastasis was 22.6+/-20.2mos (3-120mos). The impact of 24 clinicopathological features on disease specific survival was investigated. RESULTS: On univariate analysis, constitutional symptoms, sarcomatoid differentiation, tumor necrosis, multiple primary lesions, liver metastasis, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), thrombocytosis, alkaline phosphatase, hematocrit, T stage, N stage, and nuclear grade had significant influence on survival (p<0.05). Multivariate analysis revealed the following features associated with survival: sarcomatoid differentiation [hazard ratio (HR)=2.99, p<0.001], liver metastasis (HR=2.09, p=0.002), ECOG-PS (HR=1.95, p= 0.005), N stage (HR=1.94, p=0.002), and number of metastatic sites (HR=1.76, p=0.003). An individual prognostic score was defined as the sum of the weight of these features. According to prognostic scores, patients could be subdivided into 3 groups: low risk (score 0), intermediate risk (score 1 or 2), and high risk (score> or =3). CONCLUSION: A comprehensive prognostic stratification model was developed to predict survival and stratify patients for prospective clinical trials.

Keyword

Carcinoma; renal cell; neoplasm metastasis; nephrectomy; immunotherapy; prognosis

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Renal Cell/pathology/*therapy
Combined Modality Therapy
Disease-Free Survival
Female
Humans
Immunotherapy/methods
Kidney Neoplasms/pathology/*therapy
Male
Middle Aged
Multivariate Analysis
Neoplasm Metastasis
Neoplasm Staging
Nephrectomy/methods
Prognosis
Retrospective Studies

Figure

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  Fig. 1 Disease-specific survival curves according to risk scores (A) and risk groups (B). p value = 0.001 between low risk and intermediate risk, p value < 0.001 between intermediate risk and high risk.

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