Angiogenesis and other markers for prediction of survival in metastatic renal cell carcinoma.
OBJECTIVE
The treatment of metastatic renal cell carcinoma (RCC) remains a clinical challenge. Factors predicting any benefit of different therapies would therefore be useful. Angiogenesis is important in tumor progression and the development of metastases. The aim of this study in patients with distant metastases at diagnosis was to evaluate possible outcome information obtained with a number of soluble angiogenic variables in serum.


METHODS
Serum samples were taken at diagnosis from 120 consecutive patients with metastatic RCC who were operated on with radical nephrectomy. Different clinicopathological variables and vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor-1 (VEGFR-1), basic fibroblast growth factor (bFGF) and erythropoietin levels in serum were compared with the clinical course.


RESULTS
The median survival time for all patients was 9 months. Six patients (5%) died during the postoperative period, all of whom had a performance status (PS) of 2 or 3. None of the angiogenic factors (VEGF, VEGFR-1, bFGF, erythropoietin) gave any prognostic information, except that VEGF was associated with survival (p = 0.0234) in patients with a good PS. A number of other variables gave prognostic information in univariate analysis but, after multivariate analysis, only PS (p = 0.002), the number of metastatic sites (p = 0.003) and capsule invasion (p = 0.017) remained as independent predictive factors.


CONCLUSIONS
Among predictive factors, only PS, the number of metastatic sites and capsule invasion independently predicted survival in patients with metastatic RCC, while soluble angiogenic factors in serum gave no prognostic information. Nephrectomy in patients with metastatic RCC remains controversial but long-term survival can be achieved in selected patients, especially those with a good PS.
Alamdari
Farhood Iranparvar
FI
Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
Rasmuson
Torgny
T
Grankvist
Kjell
K
Ljungberg
Börje
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D018450:Disease Progression; D004921:Erythropoietin / Q000097:blood; D005260:Female; D016222:Fibroblast Growth Factor 2 / Q000097:blood; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D042461:Vascular Endothelial Growth Factor A / Q000097:blood; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood
D042461:Vascular Endothelial Growth Factor A; D016222:Fibroblast Growth Factor 2; D004921:Erythropoietin; D040281:Vascular Endothelial Growth Factor Receptor-1