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Scoring algorithm to predict survival after nephrectomy and immunotherapy in patients with metastatic renal cell carcinoma
Author(s) -
Leibovich Bradley C.,
Han Kenryu,
Bui Matthew H. T.,
Pantuck Allan J.,
Dorey Frederick J.,
Figlin Robert A.,
Belldegrun Arie
Publication year - 2003
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.11851
Subject(s) - medicine , nephrectomy , renal cell carcinoma , stage (stratigraphy) , lymph node , proportional hazards model , univariate analysis , multivariate analysis , kidney cancer , nomogram , oncology , survival analysis , urology , kidney , paleontology , biology
Abstract BACKGROUND The objective of this study was to develop an algorithm capable of stratifying the survival of patients with metastatic renal cell carcinoma (RCC) after nephrectomy and immunotherapy. METHODS The medical records of 173 patients who underwent radical nephrectomy for metastatic RCC and received recombinant interleukin‐2 (IL‐2)‐based immunotherapy between 1989 and 2000 were evaluated. Survival was the primary endpoint and was assessed based on clinical, surgical, and pathologic parameters. The clinical parameters included age, gender, performance status, existing hypertension, thyroid‐stimulating hormone (TSH) levels, location of metastases, and presenting symptomatology. The surgical features included the requirement for blood transfusion or adrenalectomy. The pathologic factors involved tumor stage, tumor size, nuclear grade, lymph node status, and histologic subtype. Disease‐specific survival was estimated using the Kaplan–Meier method. Univariate and multivariate Cox proportional hazards models were used to determine associations between clinical and pathologic features and survival. RESULTS The median follow‐up was 3.2 years (range, 0.2–9.3 years). Death due to RCC occurred in 123 patients (71%) at a median of 13 months (range, from 0.1 months to 8.4 years) after nephrectomy. Multivariate analysis revealed that the following features were associated with survival: lymph node status ( P = 0.002), constitutional symptoms ( P = 0.005), location of metastases ( P < 0.001), sarcomatoid histology ( P = 0.003), and TSH level ( P = 0.038). A scoring system based on the features in the multivariate model was created to stratify patients into low‐risk, intermediate‐risk, and high‐risk groups. Estimated survival rates at 1 years, 3 years, and 5 years were 92%, 61%, and 41%, respectively, for the low‐risk group and 66%, 31%, and 19%, respectively, for the intermediate risk group. The high‐risk group had 1% survival at 1 year and no survivors at 3 years. CONCLUSIONS In patients with metastatic RCC who were treated with nephrectomy and IL‐2 immunotherapy, regional lymph node status, constitutional symptoms, location of metastases, sarcomatoid histology, and TSH levels were associated with survival. The authors present a scoring algorithm based on these features that can be used to predict survival in patients who present with metastatic RCC and to stratify such patients for prospective clinical trials. Cancer 2003;98:2566–75. © 2003 American Cancer Society.