Metastatic renal carcinoma comprehensive prognostic system

Abstract

The purpose of the study was to identify a comprehensive prognostic system of pretreatment clinical parameters in 425 patients (pts) with metastatic renal-cell carcinoma treated with different subcutaneous (s.c.) recombinant cytokine-based home therapies in consecutive trials. Treatment consisted of (A) s.c. interferon-a2a (INF-a), s.c. interleukin-2 (IL-2) (n ¼ 102 pts), (B) s.c. IFN-a2a, s.c. IL-2, and i.v. 5-fluorouracil (5-FU) (n ¼ 235 pts) or (C) s.c. IFN-a2a, s.c. IL-2, and i.v. 5-FU combined with p.o. 13-cis-retinoic acid (13cRA) (n ¼ 88 pts). Kaplan -Meier survival analysis, log-rank statistics, and Cox regression analysis were employed to identify risk factors and to create a multiple risk factor model. The following pretreatment risk factors were identified by univariate analysis: (1) three and more metastatic sites, (2) presence of liver, lymph node or bone metastases, (3) neutrophil count X6500 cells ml À1 , (4) serum lactate dehydrogenase level (LDH) X220 U l À1 , and (5) serum C-reactive protein level (CRP) X11 mg l À1 . Cox regression analysis with forward stepwise variable selection identified neutrophil count as the major prognostic factor (hazard ratio ¼ 1.9, Po0.001), while serum levels of LDH and CRP, time between diagnosis of tumour and onset of metastatic disease, number of metastatic sites, and bone metastases were significant but somewhat less important prognostic variables within the multiple risk factor model (hazard ratio p1.5). Patients were assigned to one of the three risk groups according to cumulative risk defined as the sum of simplified risk s.c.ores for six pretreatment variables. Low-, intermediate-, and high-risk patients achieved a median overall survival of 32+ months (95% CI 24, 43; 5-year survival of 27%), 18+ months (95% CI 15, 20; 5-year survival of 11%), and 8+ months (95% CI 6, 10; 5-year survival of 5%), respectively. These prognostic categories are helpful both in individual patient care and in the assessment of patients entering prospective clinical trials.

Evaluation of the prognostic value of systemic inflammation and socioeconomic deprivation in patients with resectable colorectal liver metastases

“…[13][14][15][16][20][21][22][23] Little information is available regarding the prognostic role of the SIR in patients undergoing resection of CLM. Elevated CRP was recently demonstrated to independently predict outcome following metastasectomy.…”

“…2,13,20,23,26,31,39 For simplicity, high numbers of cells indicates cell numbers higher than the cut-off levels and low numbers of cells indicates cell numbers lower than the cut-off levels. Carstairs deprivation scores were analysed following allocation into established UK-based score quintiles.…”

“…As reported previously, 20,22,26,41 a simple prognostic score for overall survival was derived from variables maintaining significance on multivariable analysis.…”

“…2,[17][18][19] Cellular components of the SIR have also been shown to have prognostic significance in malignancy, though published data are scarce compared to that relating to CRP. Elevated neutrophil, monocyte and/or total leucocyte counts have been reported to predict adverse outcome in patients with a variety of solid tumours, [20][21][22] including primary CRC. 23 In the context of resectable CLM, examination of cellular indices of the SIR has been limited to assessment of the neutrophil-lymphocyte ratio (NLR), an index derived as a marker of the systemic inflammation associated with cardiovascular disease and critical illness.…”

Is treatment with interferon-α effective in all patients with metastatic renal carcinoma? A new approach to the investigation of interactions

“…These include performance status, recent weight loss, disease-free interval, pretreatment ESR, lactate dehydrogenase (LDH), neutrophils, haemoglobin, extrapulmonary and bone metastases, and the number of metastatic sites (Elson et al, 1988;Palmer et al, 1992;Lopez-Hänninen et al, 1996;Gelb, 1997;Culine et al, 1998;Hoffmann et al, 1999;Motzer et al, 1999Motzer et al, , 2002. A recent study of 425 good performance status patients added C-reactive protein (CRP) to this list and presented a model based on neutrophils, CRP, LDH, time from primary diagnosis to metastases, number of metastatic sites and presence of bone metastases (Atzpodien et al, 2003). Negrier et al (2002) analysed the details of 782 patients enrolled in successive multicentre trials using cytokine regimens.…”