De Forges et al evaluated patients with metastatic renal cell carcinoma and identified risk factors associated with survival. This can help identify patients who may benefit from more aggressive or novel therapies and patients who can be treated more conservatively. The authors are from the Institut Gustave-Roussy in Villejuif, France.
Parameters:
(1) erythrocyte sedimentation rate (ESR) and/or weight loss
(2) hepatic metastases
(3) lung metastases
(4) disease free interval
|
Parameter |
Finding |
Points |
|
ESR and/or weight loss |
ESR < 100 mm/h AND weight loss < 10% |
0 |
|
|
ESR >= 100 mm/h OR weight loss >= 10% |
1 |
|
hepatic metastases |
absent |
0 |
|
|
present |
1 |
|
lung metastases |
absent |
0 |
|
|
<= 5 present AND all < 2 cm |
0 |
|
|
> 5 present OR largest >= 2 cm |
1 |
|
disease-free interval |
0 months |
1 |
|
|
>= 1 month |
0 |
where:
• For weight loss, no assignment was made for 10%. I included = 10% with the 1 point group.
• A disease free interval of 0 months indicates that the patient had unresectable and/or metastatic disease at the time of presentation.
|
ESR & WL |
hepatic metastases |
lung metastases |
disease-free |
group |
observed 1 year survival |
|
0 |
0 |
0 |
0 |
1 |
77% |
|
0 |
0 |
0 |
1 |
2 |
78% |
|
0 |
0 |
1 |
0 |
3 |
75% |
|
0 |
1 |
0 |
0 |
4 |
46% |
|
0 |
0 |
1 |
1 |
4 |
46% |
|
1 |
0 |
0 |
0 |
4 |
46% |
|
0 |
1 |
0 |
1 |
5 |
31% |
|
1 |
0 |
0 |
1 |
5 |
31% |
|
0 |
1 |
1 |
0 |
6 |
5% |
|
0 |
1 |
1 |
1 |
6 |
5% |
|
1 |
0 |
1 |
0 |
6 |
5% |
|
1 |
0 |
1 |
1 |
6 |
5% |
|
1 |
1 |
0 |
0 |
6 |
5% |
|
1 |
1 |
0 |
1 |
6 |
5% |
|
1 |
1 |
1 |
0 |
6 |
5% |
|
1 |
1 |
1 |
1 |
6 |
5% |
after Table VI, page 153.
where:
• Group 6 consists of those with (1) both hepatic and lung metastases and/or (2) increased ESR-WL and metastases to lung or liver.
According to the paper, patient survival can be predicted using a Cox model (page 152):
w =
= EXP(-1.296 + (1.1 * (points for ESR/WL)) + (0.98 * (points for hepatic metastases)) + (0.69 * (points for lung metastases)) + (0.39 * (points for disease-free interval)))
survival rate for patient for time "t" =
= (survival of whole population at time "t") ^ w
When data is entered into these equations, results do not match those presented in Table VI on page 153. As shown in the lower portion of the spreadsheet, closer values are obtained if the equation is assumed to meet a logistic regression model.
Specialty: Hematology Oncology, Surgery, general, Nephrology
ICD-10: ,
