A Comprehensive Prognostic Stratification for Patients with Metastatic Renal Clear Cell Carcinoma.
10.3349/ymj.2008.49.3.451
- Author:
Kang Su CHO
1
;
Young Deuk CHOI
;
Se Joong KIM
;
Chun Il KIM
;
Byung Ha CHUNG
;
Do Hwan SEONG
;
Dong Hyeon LEE
;
Jin Seon CHO
;
In Rae CHO
;
Sung Joon HONG
Author Information
1. Department of Urology, Urological Science Institute, Yonsei University, Seoul, Korea. sjhong346@yuhs.ac
- Publication Type:Original Article
- Keywords:
Carcinoma;
renal cell;
neoplasm metastasis;
nephrectomy;
immunotherapy;
prognosis
- MeSH:
Adult;
Aged;
Aged, 80 and over;
Carcinoma, Renal Cell/pathology/*therapy;
Combined Modality Therapy;
Disease-Free Survival;
Female;
Humans;
Immunotherapy/methods;
Kidney Neoplasms/pathology/*therapy;
Male;
Middle Aged;
Multivariate Analysis;
Neoplasm Metastasis;
Neoplasm Staging;
Nephrectomy/methods;
Prognosis;
Retrospective Studies
- From:Yonsei Medical Journal
2008;49(3):451-458
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: To develop a reliable prognostic model for patients with metastatic renal cell carcinoma (RCC) based on features readily available in common clinical settings. PATIENTS AND 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 (24-83yrs) and mean survival time from metastasis was 22.6+/-20.2mos (3-120mos). 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). CONCLUSION: A comprehensive prognostic stratification model was developed to predict survival and stratify patients for prospective clinical trials.
