title: Prognostic factors associated with long-term survival in previously untreated metastatic renal cell carcinoma.
abstract: OBJECTIVE
  To identify prognostic factors (PF) for long-term survival in metastatic renal cell carcinoma (RCC) patients.
  
  
  METHODS
  We retrospectively reviewed a metastatic RCC database at the Cleveland Clinic Foundation consisting of 358 previously untreated patients who were enrolled in institutional review board-approved clinical trials of immunotherapy and/or chemotherapy at our institution from 1987 to 2002. In order to identify patient characteristics associated with long-term survival, we compared 226 'short-term' survivors [defined as overall survival (OS) <2 years] with 31 'long-term' survivors (OS >or=5 years).
  
  
  RESULTS
  Using logistic regression models, four adverse PF were identified as independent predictors of long-term survival: hemoglobin less than the lower limit of normal, greater than two metastatic sites, involved kidney (left), and Eastern Cooperative Oncology Group (ECOG) performance status (PS). Using the number of poor prognostic features present, three distinct risk groups could be identified. Patients with 0 or 1 adverse prognostic feature present had an observed likelihood of long-term survival of 32% (21/66) compared with 9% (8/91) for patients with two adverse features present and only 1% (1/93) for patients with more than two adverse features.
  
  
  CONCLUSIONS
  Independent predictors of long-term survival in previously untreated metastatic RCC include baseline hemoglobin level, number of involved sites, involved kidney, and ECOG PS. Incorporation of these factors into a simple prognostic scoring system enables three distinct groups of patients to be identified.
authors.affiliation: Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Center, OH 44195, USA. choueit@ccf.org
authors.forename: T K
authors.initials: TK
authors.lastname: Choueiri
authors.forename: Bi
authors.initials: B
authors.lastname: Rini
authors.forename: J A
authors.initials: JA
authors.lastname: Garcia
authors.forename: R C
authors.initials: RC
authors.lastname: Baz
authors.forename: R M
authors.initials: RM
authors.lastname: Abou-Jawde
authors.forename: S G
authors.initials: SG
authors.lastname: Thakkar
authors.forename: P
authors.initials: P
authors.lastname: Elson
authors.forename: T M
authors.initials: TM
authors.lastname: Mekhail
authors.forename: M
authors.initials: M
authors.lastname: Zhou
authors.forename: R M
authors.initials: RM
authors.lastname: Bukowski
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D002292:Carcinoma, Renal Cell / Q000737:chemistry / Q000401:mortality* / Q000556:secondary; D017321:Clinical Trials, Phase I as Topic; D017322:Clinical Trials, Phase II as Topic; D003131:Combined Modality Therapy; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007680:Kidney Neoplasms / Q000737:chemistry / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
chemical_list: D014408:Biomarkers, Tumor; D006454:Hemoglobins