[PDF][PDF] Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma

RJ Motzer, M Mazumdar, J Bacik, W Berg… - Journal of clinical …, 1999 - academia.edu
RJ Motzer, M Mazumdar, J Bacik, W Berg, A Amsterdam, J Ferrara
Journal of clinical oncology, 1999academia.edu
Purpose: To identify prognostic factors and a model predictive for survival in patients w ith
metastatic renalcell carcinoma (RCC). Patients and Methods: The relationship betw een
pretreatment clinical features and survival w as studied in 670 patients w ith advanced
RCCtreated in 24 Memorial Sloan-Kettering Cancer Center clinical trials between 1975 and
1996. Clinical features were first examined univariately. A stepwise modeling approach
based on Cox proportional hazards regression w as then used to form a multivariate model …
Purpose: To identify prognostic factors and a model predictive for survival in patients w ith metastatic renalcell carcinoma (RCC).
Patients and Methods: The relationship betw een pretreatment clinical features and survival w as studied in 670 patients w ith advanced RCCtreated in 24 Memorial Sloan-Kettering Cancer Center clinical trials between 1975 and 1996. Clinical features were first examined univariately. A stepwise modeling approach based on Cox proportional hazards regression w as then used to form a multivariate model. The predictive performance of the model was internally validated through a twostep nonparametricbootstrapping process. Results: The median survival time was 10 months (95% confidence interval [CI], 9 to 11 months). Fiftyseven of 670 patients remain alive, and the median follow-up time for survivors was 33 months. Pretreatment features associated w ith a shorter survival in the multivariate analysisw ere low Karnofsky performance status (F80%), high serum lactate dehydrogenase (G 1.5 times upper limit of normal), low hemoglobin (F low er limit of normal), high ‘‘corrected’’serum calcium (G 10 mg/dL), and absence of prior nephrectomy. These w ere used as risk factors to categorize patients into three different groups. The median time to death in the 25% of patients w ith zero risk factors (favorable-risk) w as 20 months. Fifty-three percent of the patients had one or two risk factors (intermediate-risk), and the median survival time in this group w as 10 months. Patients w ith three or more risk factors (poor-risk), w ho comprised 22% of the patients, had a median survival time of 4 months. Conclusions: Five prognostic factors for predicting survival w ere identified and used to categorize patients w ith metastaticRCC into three risk groups, for w hich the median survival times w ere separated by 6 months or more. These risk categories can be used in clinical trial design and interpretation and in patient management. The low long-term survival rate emphasizes the priority of clinical investigation to identify more effective therapy. J Clin Oncol 17: 2530-2540. 1999 by American Society of Clinical Oncology.
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