title: Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma.
abstract: OBJECTIVE
  To validate the Motzer et al prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma (RCC) and to identify additional independent prognostic factors.
  
  
  METHODS
  Data were collected on 353 previously untreated metastatic RCC patients enrolled onto clinical trials between 1987 and 2002.
  
  
  RESULTS
  Four of the five prognostic factors identified by Motzer were independent predictors of survival. In addition, prior radiotherapy and presence of hepatic, lung, and retroperitoneal nodal metastases were found to be independent prognostic factors. Using the number of metastatic sites as surrogate for individual sites (none or one v two or three sites), Motzer's definitions of risk groups were expanded to accommodate these two additional prognostic factors. Using this expanded criteria, favorable risk is defined as zero or one poor prognostic factor, intermediate risk is two poor prognostic factors, and poor risk is more than two poor prognostic factors. According to Motzer's definitions, 19% of patients were favorable risk, 70% were intermediate risk, and 11% were poor risk; median overall survival times for these groups were 28.6, 14.6, and 4.5 months, respectively (P < .0001). Using the expanded criteria, 37% of patients were favorable risk, 35% were intermediate risk, and 28% were poor risk; median overall survival times of these groups were 26.0, 14.4, and 7.3 months, respectively (P < .0001).
  
  
  CONCLUSIONS
  These data validate the model described by Motzer et al. Additional independent prognostic factors identified were prior radiotherapy and sites of metastasis. Incorporation of these additional prognostic factors into the Motzer et al model can help better define favorable risk, intermediate risk, and poor risk patients.
authors.affiliation: Taussig Cancer Center, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA. mekhait@cc.ccf.org
authors.forename: Tarek M
authors.initials: TM
authors.lastname: Mekhail
authors.forename: Rony M
authors.initials: RM
authors.lastname: Abou-Jawde
authors.forename: Gabriel
authors.initials: G
authors.lastname: Boumerhi
authors.forename: Sareena
authors.initials: S
authors.lastname: Malhi
authors.forename: Laura
authors.initials: L
authors.lastname: Wood
authors.forename: Paul
authors.initials: P
authors.lastname: Elson
authors.forename: Ronald
authors.initials: R
authors.lastname: Bukowski
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate