A Comprehensive Prognostic Stratification for Patients with Metastatic Renal Clear Cell Carcinoma

다국어 초록 (Multilingual 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 ≥3). Conclusion: A comprehensive prognostic stratification model was developed to predict survival and stratify patients for prospective clinical trials.

참고문헌 (Reference)

1 Jones M, "The impact of interleukin-2 on survival in renal cancer: a multivariate analysis" 8 : 275-288, 1993

2 Pantuck AJ, "The changing natural history of renal cell carcinoma" 166 : 1611-1623, 2001

3 Leibovich BC, "Scoring algorithm to predict survival after nephrectomy and immunotherapy in patients with metastatic renal cell carcinoma: a stratification tool for prospective clinical trials" 98 : 2566-2575, 2003

4 Zisman A, "Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma" 20 : 4559-4566, 2002

5 Motzer RJ, "Renal-cell carcinoma" 335 : 865-875, 1996

6 Tripathi RT, "Racial disparity in outcomes of a clinical trial population with metastatic renal cell carcinoma" 68 : 696-301, 2006

7 Amin MB, "Prognostic impact of histologic subtyping of adult renal epithelial neoplasms: an experience of 405 cases" 26 : 281-291, 2002

8 de Forges A, "Prognostic factors of adult metastatic renal carcinoma: a multivariate analysis" 4 : 149-154, 1988

9 Elson PJ, "Prognostic factors for survival in patients with recurrent or metastatic renal cell carcinoma" 48 : 7310-7313, 1988

10 Palmer PA, "Prognostic factors for survival in patients with advanced renal cell carcinoma treated with recombinant interleukin-2" 3 : 475-480, 1992

11 Fosså SD, "Prognostic factors and survival in patients with metastatic renal cell carcinoma treated with chemotherapy or interferon-alpha" 30A : 1310-1314, 1994

12 Bellmunt J, "Present strategies in the treatment of metastatic renal cell carcinoma: an update on molecular targeting agents" 99 : 274-280, 2007

13 Flanigan RC, "Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer" 345 : 1655-1659, 2001

14 Lopez Hänninen E, "Interleukin-2 based home therapy of metastatic renal cell carcinoma: risks and benefits in 215 consecutive single institution patients" 155 : 19-25, 1996

15 Motzer RJ, "Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma" 20 : 289-296, 2002

16 Zisman A, "Improved prognostication of renal cell carcinoma using an integrated staging system" 19 : 1649-1657, 2001

17 Mickisch GH, "European Organisation for Research and Treatment of Cancer (EORTC) Genitourinary Group. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial" 358 : 966-970, 2001

18 Berndt SI, "Disparities in treatment and outcome for renal cell cancer among older black and white patients" 25 : 3589-3595, 2007

19 Atzpodien J, "DGCIN- German Cooperative Renal Carcinoma Chemo- Immunotherap Trial Group. Metastatic renal carcinoma comprehensive prognostic system" 88 : 348-353, 2003

20 Frank I, "An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score" 168 : 2395-2400, 2002

21 Motzer RJ, "Amsterdam A, Ferrara J. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma" 17 : 2530-2540, 1999

22 Leibovich BC, "A scoring algorithm to predict survival for patients with metastatic clear cell renal cell carcinoma: a stratification tool for prospective clinical trials" 174 : 1759-1763, 2005