Outcomes According to MSKCC Risk Score with Focus on the Intermediate-Risk Group in Metastatic Renal Cell Carcinoma Patients Treated with First-Line Sunitinib: A Retrospective Analysis of 2390 Patients

Abstract

Background: The Memorial Sloan–Kettering Cancer Center (MSKCC) prognostic model has been widely used for the prediction of the outcome of metastatic renal cell carcinoma (mRCC) patients treated with systemic therapies, however, data from large studies are limited. This study aimed at the evaluation of the impact of the MSKCC score on the outcomes in mRCC patients treated with first-line sunitinib, with a focus on the intermediate-risk group. Methods: Clinical data from 2390 mRCC patients were analysed retrospectively. Progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were analysed according to the MSKCC risk score. Results: ORR, median PFS, and OS for patients with one risk factor were 26.7%, 10.1, and 28.2 months versus 18.7%, 6.2, and 16.2 months, respectively, for those with two risk factors (ORR: p = 0.001, PFS: p < 0.001, OS: p < 0.001). ORR, median PFS, and OS were 33.0%, 17.0, and 44.7 months versus 24.1%, 9.0, and 24.1 months versus 13.4%, 4.5, and 9.5 months in the favourable-, intermediate-, and poor-risk groups, respectively (ORR: p < 0.001, PFS: p < 0.001, OS: p < 0.001). Conclusions: The results of the present retrospective study demonstrate the suitability of the MSKCC model in mRCC patients treated with first-line sunitinib and suggest different outcomes between patients with one or two risk factors.

Real-World Outcomes in Patients with Metastatic Renal Cell Carcinoma According to Risk Factors: The STAR-TOR Registry

“…Outcomes from this analysis were generally consistent with those from other studies [9][10][11][12][13][14][15], including analyses from other large databases [9,13,14]. A retrospective analysis of the 375 sunitinib-treated patients enrolled in the pivotal sunitinib versus interferon-α Phase III trial reported substantial differences in OS for patients of intermediate risk with 1 RF (IMDC, 28.2 months; MSKCC, 23.1 months) compared with patients with 2 RFs (IMDC, 16.3 months; MSKCC 16.7 months) [11].…”

“…Notably, there was no statistically significant difference in OS for patients with 0 versus 1 RF stratified by IMDC. This suggests that patients with 1 IMDC RF (intermediate-risk group) have similar outcomes to IMDC favorable-risk patients, adding to the evidence that the intermediate group is heterogenous [9][10][11][12][13][14][15]24]. Consistently, OS was significantly longer for patients with 1 IMDC RF than for patients with 2 IMDC RFs.…”

“…Our analysis found that PFS did not differ significantly between patients with 1 or 2 RFs, whether stratified by IMDC or MSKCC. In contrast, other analyses have reported significant differences between patients with 1 or 2 RFs for both prognostic models [10,12,14]. This may be partly explained by the method of assessment.…”

“…Consistently, an analysis of 1769 patients in the IMDC reported significantly longer OS in patients with 1 IMDC RF (35.1 months) compared with patients with 2 IMDC RFs (21.9 months) [13]. A recent, large analysis of 2390 patients enrolled in the RenIS registry and stratified according to MSKCC reported significantly longer OS for patients with 1 RF compared with patients with 2 MSKCC RFs (28.2 vs 16.2 months; p < 0.001) [14]. Further stratification of patients with intermediate risk may therefore help in guiding treatment selection with the aim of improving OS.…”

“…Treatment results typically vary according to patient risk groups, with potentially poorer outcomes for patients with ≥4 IMDC RFs or poor risk by MSKCC [8]. Over 50% of patients are classified as intermediate risk according to the IMDC and MSKCC prognostic models [5]; however, an increasing body of evidence suggests that the intermediate-risk group is heterogeneous [9][10][11][12][13][14][15] with important implications for treatment selection, patient counseling and stratification.…”