2.5 Prognostic factors

2.5 Prognostic factors^1–5

Prognostic factors can be divided into

Anatomical (TNM classification)
Histopathological
Clinical
Molecular/genomic

Prognostic factors can be used both in patients with local disease (predictive risk of recurrence), but also in patients with disseminated disease (providing an estimate of median survival). In general, it is recommended to use TNM and histopathological factors for local disease and the clinical prognostic model developed by IMDC for patients with disseminated disease.

Anatomical prognostic factors

The TNM classification is used here (See section on anatomical staging of RCC). Generally speaking, the higher the stage, the poorer the prognosis.

Histopathological prognostic factors

See section on historic classification of RCC

This includes the following parameters:

RCC subtype
WHO and Fuhrman grading system
Vascular invasion
Tumour necrosis
Presence of sarcomatoid/rhabdoid dedifferentiation

Clinical prognostic factors

Performance status
Symptoms of cancer
Anaemia
Neutrophil/lymphocyte ratio
CRP

Prognostic models incorporating several clinical factors, e.g. IMDC , used to stratify patients with disseminated kidney cancer.

Molecular/genomic factors

Links have been found between several mutations, incl. PBRM1, SETD2, and BAP1 and risk of recurrence or poorer survival. However, it is not routinely used in the clinic.

References

Prognostication in Kidney Cancer: Recent Advances and Future Directions Jeffrey Graham, Shaan Dudani, and Daniel Y.C. Heng
EAU guidelines on renal cell carcinoma:
B. Ljungberg (Chair), L. Albiges, K. Bensalah, A. Bex (Vice-chair), R.H. Giles (Patient Advocate), M. Hora, M.A. Kuczyk, T. Lam, L. Marconi, A.S. Merseburger, T. Powles,M. Staehler, A. Volpe Guidelines Associates: S. Dabestani, S. Fernández-Pello Montes, F. Hofmann, R. Tahbaz
Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†
B. Escudier1, C. Porta2, M. Schmidinger3, N. Rioux-Leclercq4, A. Bex5, V. Khoo6,7, V. Gruenvald8 & A. Horwich9 on behalf of the ESMO Guidelines Committee*