February 22, 2007

Prognostic Factors Associated With Long-Term Survival In Previously Untreated Metastatic Renal Cell Carcinoma

UroToday.com- Patients with metastatic renal cell carcinoma (mRCC) overall have a poor prognosis, with median survival in the range of one year. However, there remains a subset of patients (around 10%) who, despite having metastatic disease, demonstrate a prolonged survival, sometimes in excess of 5 years. In this study by Choueiri and colleagues out of the Cleveland Clinic, they evaluated their experience with mRCC patients to identify clinical parameters associated with long-term survival.

In this study, the authors evaluated 358 patients with untreated metastatic RCC, enrolled in phase I/II studies over a 15 year period to identify clinical parameters associated with long-term survival. They defined long-term survival as patients with an overall survival (OS) ≥ 5 years, and defined short-term survival as patients with an OS < 2 years. In their series they identified 226 patients with short-term survival and compared them to 31 patients with long-term survival. One hundred one patients were eliminated from the analysis due to incomplete follow-up, or those that had an OS between 2 and 5 years. While patients received a variety of systemic therapies, the type of therapy received did not influence outcome (p=0.55). In their multivariate analysis, the factors that predicted against long-term OS (≥ 5 years) included hemoglobin less than the lower limit of normal (p<0.001), more than 2 sites of metastatic disease (p=0.006), involvement of the left kidney (versus right) (p=0.003), and ECOG performance status of 1 (versus 0) (p=0.03). Improved response to therapy was noted in the long-term survivors (30% partial/complete response) when compared to short-term survivors (6% partial/complete response) (p<0.001). The authors then used the 4 clinical parameters that predicted outcome to group patients into 3 specific risk subsets. Thirty-two percent of patients with 0 or 1 risk factors had an OS of ≥ 5 years, 9% of patients with 2 risk factors had an OS of ≥ 5 years, and only 1% of patients with more than 2 risk factors had an OS of ≥ 5 years.

The authors conclude that hemoglobin levels, ECOG performance status, sites of metastases, and laterality of the primary tumor (left versus right) are predictive of long-term survival in patients with untreated mRCC. These factors should be considered in counseling patients regarding outcomes, but await further prospective validation before prior to widespread implementation in prognostic nomograms.

T. K. Choueiri, B. I. Rini, J. A. Garcia, R. C. Baz, R. M. Abou-Jawde, S. G. Thakkar, P. Elson, T. M. Mekhail, M. Zhou, and R. M. Bukowski
Annals of Oncology (Epub October 23, 2006)

Reviewed by UroToday.com Medical Editor Christopher G. Wood

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