title: How can we improve prognostic models in renal cell carcinoma?
abstract: The therapeutic improvements in renal cell carcinoma brought about by the transition from the 'cytokine era' to the 'targeted agents era', have not affected the peculiar prognostic heterogeneity of the disease, nor have they diminished the importance of risk group classification based on easily assessable and commonly available laboratory and clinical variables. In the landmark study conducted by Motzer et al. before biological agents were available, the median survival of patients in the good prognosis group was 20 months, while the patients in the poor-risk group had a median survival time of only 4 months. With the introduction of anti-VEGF agents, overall survival has approximately doubled in all risk classes. In a population-based analysis of 670 patients treated with anti-VEGF agents, either in the first-line setting or in the second-line setting after cytokines, stratification according to the Database Consortium model showed that patients in the favorable risk group had a median overall survival of 43.2 months, while patients in the poor-risk group had a median overall survival of 7.8 months.
authors.affiliation: Division of Medical Oncology, CROB - IRCCS , Rionero in Vulture , Italy +0972 726111 ; +0972 723509 ; carbuone@hotmail.com.
authors.forename: Carlo
authors.initials: C
authors.lastname: Buonerba
authors.forename: Matteo
authors.initials: M
authors.lastname: Ferro
authors.forename: Francesco
authors.initials: F
authors.lastname: Perri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Calderoni
authors.forename: Pina
authors.initials: P
authors.lastname: Mambella
authors.forename: Pasqualina
authors.initials: P
authors.lastname: Giordano
authors.forename: Prisco
authors.initials: P
authors.lastname: Piscitelli
authors.forename: Vittorino
authors.initials: V
authors.lastname: Montanaro
authors.forename: Michele
authors.initials: M
authors.lastname: Aieta
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Lorenzo
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D008962:Models, Theoretical; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D000970:Antineoplastic Agents; D042461:Vascular Endothelial Growth Factor A
keywords: biological therapy; concordance index; kidney cancer; prognostic models