Malhi et al identified prognostic factors associated with response to therapy or rapid progression in patients with metastatic renal cell carcinoma. These can help identify patients who may benefit from novel or more aggressive management. The authors are from the Cleveland Clinic Foundation.
Parameters:
(1) gender
(2) history of nephrectomy (removing the primary tumor)
(3) sites of metastases
(4) ECOG performance scale
(5) pretreatment laboratory values
Outcomes:
(1) complete or partial response to therapy (favorable response)
(2) progression or death within 2 months (rapid progression)
Favorable Response to Therapy
|
Parameters |
Findings |
Points |
|
gender of the patient |
male |
0 |
|
|
female |
1 |
|
history of nephrectomy |
no |
0 |
|
|
yes |
1 |
|
bony metastases |
absent |
0 |
|
|
present |
1 |
|
liver metastases |
absent |
1 |
|
|
present |
0 |
number of factors associated with therapeutic response =
= SUM(points for all 4 parameters)
Interpretation:
• minimum number of factors: 0
• maximum number of factors: 4
• The more factors present the more favorable the response.
|
Number of Factors |
Favorable Response |
|
0 - 2 |
5% |
|
3 or 4 |
19% |
Rapid Disease Progression
|
Parameters |
Findings |
Points |
|
ECOG performance scale |
0 |
0 |
|
|
>= 1 |
1 |
|
history of nephrectomy |
no |
1 |
|
|
yes |
0 |
|
metastases |
lung only |
0 |
|
|
other |
1 |
|
pretreatment laboratory values |
absolute neutrophil count > 7,700 per µL and LDH < 1.5 times upper limit of normal |
1 |
|
|
other combinations |
0 |
number of factors associated with rapid progression =
= SUM(points for all 4 parameters)
Interpretation:
• minimum number of factors: 0
• maximum number of factors: 4
• The more factors present the faster the disease progression.
|
Number of Factors |
Rapid Progression |
|
0 |
14% |
|
1 |
27% |
|
2 |
38% |
|
3 or 4 |
80% |
Specialty: Hematology Oncology, Surgery, general, Nephrology
ICD-10: ,
