Management of patients with renal cell carcinoma is often difficult. Potential cure can be achieved by radical surgery of small, locoregional disease, but unresectable primary tumors or those with metastatic foci respond poorly to therapy.
Factor
Unfavorable Finding
histologic grade
Fuhrman Grade 3 or 4 of 4, high mitotic activity, abnormal DNA ploidy
histologic type
sarcomatoid pattern
stage
most important factor; T3 or T4 in TNM and stage III or IV
metastases (including to regional lymph nodes)
more than 1
site of metastases
liver
surgical resectability
unresectable (reflects high stage)
presentation
symptomatic
weight loss
present
performance status
ECOG >=2 (bedridden part or all of day)
sedimentation rate
> 30 mm/h
anemia
hemoglobin < 10 g/dL in women, or < 12 g/dL in men
Not all of these have been shown to be of independent significance by multivariate analysis.
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