title: Prognostic factors in patients receiving third line targeted therapy for metastatic renal cell carcinoma.
abstract: OBJECTIVE
  Several prognostic models have been proposed for metastatic renal cell carcinoma but none has been validated in patients who receive third line targeted agents. We evaluated prognostic factors in patients with metastatic renal cell carcinoma who received a third line targeted agent.
  
  
  METHODS
  We retrospectively reviewed data on 2,065 patients with clear cell metastatic renal cell carcinoma who were treated with targeted therapy at a total of 23 centers in Italy. Included in final analysis were 281 patients treated with 3 targeted agents. Overall survival was the main outcome. Cox proportional hazards regression followed by bootstrap validation was used to identify independent prognostic factors.
  
  
  RESULTS
  Three clinical characteristics (ECOG performance status greater than 1, metastasis at diagnosis and liver metastasis) and 2 biochemical factors (hemoglobin less than the lower limit of normal and neutrophil count greater than the upper limit of normal, respectively) were prognostic. Patients were classified into 3 risk categories, including low-zero or 1, intermediate-2 and high risk-more than 2 risk factors. Median overall survival was 19.7, 10.1 and 5.5 months, and 1-year overall survival was 71%, 43% and 15%, respectively. The major limitation was the retrospective nature of this study and absent external validation.
  
  
  CONCLUSIONS
  This nomogram included clinical and biochemical prognostic factors. In clinical trials it may be useful to select patients and define the prognosis.
authors.affiliation: Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: roberto.iacovelli@istitutotumori.mi.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Iacovelli
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza-University of Rome, Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Farcomeni
authors.affiliation: Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy.
authors.forename: Cora N
authors.initials: CN
authors.lastname: Sternberg
authors.affiliation: Oncology Unit, A. Cardarelli Hospital, Naples, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Cartenì
authors.affiliation: Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Milella
authors.affiliation: Department of Medical Oncology, Polytechnic University of the Marche Region, Ancona, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Santoni
authors.affiliation: Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy.
authors.forename: Linda
authors.initials: L
authors.lastname: Cerbone
authors.affiliation: Medical Oncology, Genitourinary Cancer Section, University Federico II, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Lorenzo
authors.affiliation: Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Verzoni
authors.affiliation: Fondazione del Piemonte per l'Oncologia IRCC, Candiolo, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Ortega
authors.affiliation: Oncology Division, Department of Oncology and Hematology, University of Modena e Reggio Emilia, Modena, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Sabbatini
authors.affiliation: Falck Division of Oncology, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ricotta
authors.affiliation: Oncology Division, Ospedali Riuniti, Bergamo, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Messina
authors.affiliation: National Cancer Research Center, Istituto Tumori "Giovanni Paolo II", Bari, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Lorusso
authors.affiliation: Medical Oncology Unit, Azienda Ospedaliero Universitaria of Cagliari, Cagliari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Atzori
authors.affiliation: Oncology and Hematology Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: De Vincenzo
authors.affiliation: Oncology Unit, St Maria della Misericordia Hospital, Udine, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: Sacco
authors.affiliation: University and IRCCS AOU-San Martino-IST, National Cancer Research Institute, Genoa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Boccardo
authors.affiliation: Medical Oncology, St. Chiara Hospital, Trento, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Valduga
authors.affiliation: Medical Oncology, "G.B. Rossi" Academic Hospital, University of Verona, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Massari
authors.affiliation: Department of Medical Oncology; Santa Maria Annunziata Hospital, Florence, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Baldazzi
authors.affiliation: Medical Oncology and Breast Unit Department, Sen A. Perrino Hospital, Brindisi, Italy.
authors.forename: Saverio
authors.initials: S
authors.lastname: Cinieri
authors.affiliation: Medical Oncology, Maggiore della Carità University Hospital, Novara, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mosca
authors.affiliation: Oncology Unit, Belcolle Hospital, Viterbo, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Maria Ruggeri
authors.affiliation: Medical Oncology, University of Brescia, Brescia, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berruti
authors.affiliation: Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Procopio
mesh_terms: D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D049451:Nomograms; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
keywords: carcinoma; kidney; neoplasm metastasis; nomograms; prognosis; renal cell