title: Prognostic factors in metastatic renal cell carcinoma: metastasectomy as independent prognostic variable.
abstract: Prognostic and predictive factors in patients with metastatic renal cell carcinoma (MRCC) have been evaluated from untreated patients or patients on several different treatment approaches. The aim of this analysis was to define prognostic and predictive factors in patients treated uniformly with a low-dose outpatient cytokine combination. The relationship between patient-, tumour-, and treatment-related factors was analysed in 99 patients with MRCC. These features were first examined in univariate analyses, then a stepwise modelling approach based on Cox regression was used to form a multivariate model. Nuclear grade, metastasectomy--even incomplete--C-reactive protein and lactate dehydrogenase were identified as independent prognostic factors for survival. Patients assigned to three different risk groups had statistically significant survival differences (30, 22 and 6 months, respectively). A total of 43.4% had undergone metastasectomy, mostly incomplete. Risk group affiliation was correlated with response to treatment. Our findings strongly suggest the consideration of metastasectomy in the management of patients with metastatic renal cell cancer undergoing either immunotherapy or targeted treatment.
authors.affiliation: Department of Medicine I, Clinical Division of Oncology, University Hospital, Waehringer Guertel 18-20, Vienna A-1090, Austria. ursula.vogl@meduniwien.ac.at
authors.forename: U M
authors.initials: UM
authors.lastname: Vogl
authors.forename: H
authors.initials: H
authors.lastname: Zehetgruber
authors.forename: M
authors.initials: M
authors.lastname: Dominkus
authors.forename: M
authors.initials: M
authors.lastname: Hejna
authors.forename: C C
authors.initials: CC
authors.lastname: Zielinski
authors.forename: A
authors.initials: A
authors.lastname: Haitel
authors.forename: M
authors.initials: M
authors.lastname: Schmidinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D011237:Predictive Value of Tests; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein; D007770:L-Lactate Dehydrogenase