Leibovich et al developed an algorithm to help predict survival in a patient with a metastatic clear cell carcinoma of the kidney. This can help stratify patients in clinical trials or identify patients who may benefit from more aggressive management. The authors are from the Mayo Clinic.
Patient selection: metastatic clear cell carcinoma of the kidney
Parameters:
(1) presence of constitutional symptoms at presentation (rash, sweats, weight loss, fatigue, early satiety, anorexia)
(2) presence of bone metastases
(3) presence of liver metastases
(4) presence of multiple metastases
(5) years between nephrectomy and diagnosis of metastases
(6) complete resection of metastatic tumor
(7) level of tumor thrombus
(8) nuclear grade of primary tumor
(9) presence of coagulative tumor necrosis
|
Thrombus Extent |
Thrombus Level |
|
limited to renal vein |
0 |
|
<= 2 cm above renal vein |
I |
|
> 2 cm above renal vein AND below hepatic veins |
II |
|
at or above level of hepatic veins but below diaphragm |
III |
|
above the diaphragm |
IV |
|
Parameter |
Finding |
Points |
|
constitutional symptoms |
absent |
0 |
|
|
present |
2 |
|
bone metastases |
absent |
0 |
|
|
present |
2 |
|
liver metastases |
absent |
0 |
|
|
present |
4 |
|
multiple metastases |
absent |
0 |
|
|
present |
2 |
|
years between nephrectomy and diagnosis of metastasis |
present at time of nephrectomy |
1 |
|
|
<= 2 years |
3 |
|
|
> 2 years |
0 |
|
complete resection of metastases |
no |
0 |
|
|
yes |
-5 |
|
level of tumor thrombus |
none |
0 |
|
|
Level 0 |
0 |
|
|
Level I to IV |
3 |
|
nuclear grade (Fuhrman) |
1, 2 or 3 |
0 |
|
|
4 |
3 |
|
coagulation tumor necrosis |
absent |
0 |
|
|
present |
2 |
where:
• For the interval between nephrectomy and diagnosis of metastasis the original table has < 2 and > 2 years, not specifying = 2 years.
• Multiple metastases appears to include both multiple metastases within 1 location and metastases to multiple locations (column 1, page 1760).
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: -5
• maximum score: 21
• The higher the score the worse the prognosis.
|
Total Score |
Cancer Specific Survival at 3 years |
|
-5 to -1 |
61% |
|
0 to 2 |
36% |
|
3 to 6 |
22% |
|
7 to 8 |
12% |
|
9 to 21 |
4% |
Specialty: Hematology Oncology, Surgery, general, Nephrology
ICD-10: ,
