A comprehensive prognostic stratification for patients with metastatic renal clear cell carcinoma.
OBJECTIVE
To develop a reliable prognostic model for patients with metastatic renal cell carcinoma (RCC) based on features readily available in common clinical settings.


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 (24-83 yrs) and mean survival time from metastasis was 22.6+/-20.2 mos (3-120 mos). 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).


CONCLUSIONS
A comprehensive prognostic stratification model was developed to predict survival and stratify patients for prospective clinical trials.
Cho
Kang Su
KS
Department of Urology, Urological Science Institute, Yonsei University, Seodaemun-gu, Seoul, Korea.
Choi
Young Deuk
YD
Kim
Se Joong
SJ
Kim
Chun Il
CI
Chung
Byung Ha
BH
Seong
Do Hwan
do H
Lee
Dong Hyeon
DH
Cho
Jin Seon
JS
Cho
In Rae
IR
Hong
Sung Joon
SJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D007680:Kidney Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies