The survival in a patient with advanced, metastatic renal cell carcinoma can be estimated from the number of adverse risk factors present. The assessment is based on data previous to any chemo- or immunotherapy. This study was based on multivariate analysis of 670 patients treated at the Memorial Sloan-Kettering Cancer Center.
NOTE: Motzer et al has published a subset of these risk factors for predicting survival for clinical trials with novel agents (see 27.23.13).
Risk factors:
(1) Karnofsky performance status
(2) serum LDH
(3) hemoglobin
(4) total calcium corrected for serum albumin
(5) history of previous nephrectomy
|
Parameter |
Finding |
Points |
|
Karnofsky performance status |
Karnofsky status >= 80% |
0 |
|
|
Karnofsky status < 80% |
1 |
|
serum LDH |
serum LDH <= 1.5 times the upper limit of the normal reference range |
0 |
|
|
serum LDH > 1.5 times the upper limit of the normal reference range |
1 |
|
hemoglobin |
hemoglobin >= lower limit of normal reference range |
0 |
|
|
hemoglobin < lower limit of normal reference range |
1 |
|
corrected calcium |
not high (<= 10 mg/dL) |
0 |
|
|
high (> 10 mg/dL) |
1 |
|
history of previous nephrectomy |
yes |
0 |
|
|
no |
1 |
corrected total calcium in mg/dL (from Orrell, 1971) =
= (total calcium in mg/dL) + (0.707 * (3.4 - (serum albumin in g/dL))
where:
• The history of previous nephrectomy probably refers to whether or not the primary renal cell carcinoma was surgically resected. This would cover a partial nephrectomy for small tumors. The variable may reflect the fact that nephrectomy is not done in unresectable or widely metastatic disease, reflecting a worse prognosis. I am not sure how prognosis would be affected by bilateral nephrectomies.
number of adverse risk factors =
= SUM(number of adverse risk factors present)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 5
• Survival decreases as the number of risk factors increase.
|
number of risk factors |
risk group |
estimated survival |
|
0 |
favorable |
20 months |
|
1 or 2 |
intermediate |
10 months |
|
3, 4 or 5 |
high |
4 months |
Purpose: To estimate the survival for a patient with advanced, metastatic renal cell carcinoma.
Specialty: Hematology Oncology, Surgery, general, Nephrology
Objective: severity, prognosis, stage
ICD-10: C64,
