title: Prognostic factors for survival in patients with metastatic renal cell carcinoma treated with targeted therapies.
abstract: BACKGROUND
  The most important prognostic factors for survival in patients with metastatic renal cell carcinoma (mRCC) were evaluated in the era of cytokine therapy, and only recently were revalidating in patients receiving targeted therapies (TTs).
  
  
  METHODS
  Clinical data for consecutive patients with mRCC who received TTs were retrieved from the database of Istituto Nazionale dei Tumori of Milan. Variables with a significant association with overall survival (OS) were estimated by proportional hazard regression, and a backward stepwise multivariate analysis identified the independent prognostic factors.
  
  
  RESULTS
  Data for 336 consecutive patients treated with TTs for RCC during the period 2004-2011 were evaluated. According to the Motzer classification, 32% patients were low risk, 48% were intermediate risk and 20% were poor risk. One hundred and sixty-seven (49.7%) patients received one TT, 116 (34.5%) received a second-line TT, 42 (12.5%) a third-line TT and 11 (3.3%) patients received a fourth-line TT. The median OS was 24 months (95% CI 20.0, 27.0) and the 5-year OS rate was 24.6% (95% CI 18.7, 30.8%). In the uni- and multivariate analysis Motzer risk classification, Fuhrman grade and previous cytokine therapy were identified as independent prognostic factors (P<0.01).
  
  
  CONCLUSIONS
  The Motzer classification was confirmed as an independent prognostic factor for OS in patients with mRCC receiving TTs. Additionally, Fuhrman grade and previous cytokine therapy were independent prognostic factors for clinical outcome.
authors.affiliation: Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. giuseppe.procopio@istitutotumori.mi.it
authors.forename: G
authors.initials: G
authors.lastname: Procopio
authors.forename: E
authors.initials: E
authors.lastname: Verzoni
authors.forename: R
authors.initials: R
authors.lastname: Iacovelli
authors.forename: D
authors.initials: D
authors.lastname: Biasoni
authors.forename: I
authors.initials: I
authors.lastname: Testa
authors.forename: L
authors.initials: L
authors.lastname: Porcu
authors.forename: F
authors.initials: F
authors.lastname: De Braud
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002292:Carcinoma, Renal Cell / Q000145:classification / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000145:classification / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis