Motzer et al evaluated patients with advanced renal cell carcinoma who were treated with interferon-alfa. This can help to identify a patient who may require more aggressive management. The authors are from Memorial Sloan-Kettering Cancer Center, Cornell University and Vanderbilt University..
NOTE: Motzer et al has published a subset of these risk factors for predicting survival for clinical trials with novel agents (see 27.23.06 and 27.23.13).
Risk factors:
(1) Karnofsky performance status
(2) serum LDH
(3) hemoglobin
(4) total calcium corrected for serum albumin
(5) interferon from initial diagnosis of renal cell carcinoma to starting interferon-alfa
|
Parameter
|
Finding
|
Points
|
|
Karnofsky performance status
|
>= 80%
|
0
|
|
|
< 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
|
|
time interval
|
< 1 year
|
1
|
|
|
>= 1 year
|
0
|
corrected total calcium in mg/dL (from Orrell, 1971) =
= (total calcium in mg/dL) + (0.707 * (3.4 - (serum albumin in g/dL))
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
|
Median Survival
|
|
0
|
favorable
|
30 months
|
|
1 or 2
|
intermediate
|
14 months
|
|
3, 4 or 5
|
high
|
5 months
|
