Prognostic factors in metastatic renal cell carcinoma: metastasectomy as independent prognostic variable

Abstract

Prognostic and predictive factors in patients with metastatic renal cell carcinoma (MRCC) have been evaluated from untreated patients or patients on several different treatment approaches. The aim of this analysis was to define prognostic and predictive factors in patients treated uniformly with a low-dose outpatient cytokine combination. The relationship between patient-, tumour-, and treatment-related factors was analysed in 99 patients with MRCC. These features were first examined in univariate analyses, then a stepwise modelling approach based on Cox regression was used to form a multivariate model. Nuclear grade, metastasectomy--even incomplete--C-reactive protein and lactate dehydrogenase were identified as independent prognostic factors for survival. Patients assigned to three different risk groups had statistically significant survival differences (30, 22 and 6 months, respectively). A total of 43.4% had undergone metastasectomy, mostly incomplete. Risk group affiliation was correlated with response to treatment. Our findings strongly suggest the consideration of metastasectomy in the management of patients with metastatic renal cell cancer undergoing either immunotherapy or targeted treatment.

Figure 1

Overall survival for the independent risk factor metastasectomy (log rank P=0.026, median overall survival 27.2 vs 20.6 months).

Figure 2

Overall survival stratified according to risk group (log rank P<0.001 for low vs medium risk and P<0.001 for medium vs high risk, median overall survival: 30.53 vs 22.1 vs 5.9 months).