2.4 Prognostic stratification tools for patients with mRCC1-9
Several prognostic stratification tools have been developed for patients with disseminated kidney cancer. Prior to the introduction of targeted therapy, where the primary treatment was cytokines, the most widely used tool was developed by Robert Motzer from Memorial Sloan Kettering Cancer Centre (MSKCC).
The following 5 risk factors for short-term survival were identified:
- Karnofsky performance status 70 or lower
- Absence of nephrectomy
- Haemoglobin <normal
- Corrected calcium > 10 mmol/dl (=elevated ionised calcium)
- LDH > 1.5 times upper normal range
| RISK FACTORS | PROGNOSTIC GROUP |
|---|---|
| 0 | Favourable |
| 1-2 | Intermediate |
| 3-5 | Poor |
The 5 risk factors are translated into 3 risk groups:
- Favourable
- Intermediate
- Poor
Professor Daniel Heng has further developed the prognostic (International Metastatic renal cell carcinoma Database Consortium model (IMDC) for patients with disseminated kidney cancer, being treated with targeted therapy.
The following risk factors for short survival have been identified:
- Karnofsky performance status 70 or lower
- Period of <1 year from diagnosis of kidney cancer to start of treatment
- Haemoglobin <normal
- Corrected calcium > 10 mmol/dl (=elevated ionised calcium)
- Neutrophils > upper limit of normal (ULN)
- Thrombocytes > ULN
| PROGNOSTIC GROUP | FIRST-LINE TREATMENTS MOS (MONTHS) | SECOND-LINE TREATMENTS MOS (MONTHS) | |
|---|---|---|---|
| 0 | Favourable | 43.2 | 35.3 |
| 1-2 | Intermediate | 22.5 | 16.6 |
| 3-5 | Poor | 7.8 | 5.4 |
MOS (mOS) = The median overall survival
In addition to number of risk factors, mOS is shown for the prognosis groups at 1st and 2nd line treatment.
The use of IMDC is recommended for risk stratification of newly-referred patients with disseminated kidney cancer. The above model can also be used for risk stratification of patients in 2nd to 4th line treatment.
References
- Prognostication in Kidney Cancer: Recent Advances and Future Directions Jeffrey Graham, Shaan Dudani, and Daniel Y.C. Heng
- ESMO guidelines
- Motzer RJ, Bacik J, Murphy BA, et al:Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 20:289-296, 2002
- Heng DYC, Xie W, Regan MM, et al: Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: Results from a large, multicentre study. J Clin Oncol 27: 5794–5799, 2009
- Heng DYC, Xie W, Regan MM, et al: External validation and comparison with other models of the International Metastatic Renal-Cell Carcinoma Database Consortium prognostic model: A population-based study. Lancet Oncol 14:141–148, 2013
- Kroeger N, Xie W, Lee JL, et al: Metastatic non-clear cell renal cell carcinoma treated with targeted therapy agents: Characterisation of survival outcome and application of the International mRCC Database Consortium criteria. Cancer 119: 2999–3006, 2013
- Ko JJ, Xie W, Kroeger N, et al: The International Metastatic Renal Cell Carcinoma Database Consortium model as a prognostic tool in patients with metastatic renal cell carcinoma previously treated with first-line targeted therapy: A population-based study. Lancet Oncol 16:293–300, 2015
- Wells JC, Stukalin I, Norton C, et al: Third-line targeted therapy in metastatic renal cell carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol 71: 204–209, 2017
- Yip S, Wells C, Brandao Moreira R, et al: Real world experience of immuno-oncology agents in metastatic renal cell carcinoma: Results from the IMDC. J Clin Oncol 35:492, 2017 (6_suppl)
