Primary Tumor Characteristics Are Important Prognostic Factors for Sorafenib-Treated Patients with Metastatic Renal Cell Carcinoma: A Retrospective Multicenter Study.

Sung Han Kim,Cheol Kwak,Tae Gyun Kwon,Sang Eun Lee,Sohee Kim,Seong Il Seo,Jinsoo Chung,Kwan Joong Joo,Tae Nam Kim,Kanghyon Song,Byung-Ho Nam,Sung-Hoo Hong,Choung-Soo Kim,Ill Young Seo

doi:10.1155/2017/9215930

Abstract

We aimed to identify prognostic factors associated with progression-free survival (PFS) and overall survival (OS) in metastatic renal cell carcinoma (mRCC) patients treated with sorafenib. We investigated 177 patients, including 116 who received sorafenib as first-line therapy, using the Cox regression model. During a median follow-up period of 19.2 months, the PFS and OS were 6.4 and 32.6 months among all patients and 7.4 months and undetermined for first-line sorafenib-treated patients, respectively. Clinical T3-4 stage (hazard ratio [HR] 2.56) and a primary tumor size >7 cm (HR 0.34) were significant prognostic factors for PFS among all patients, as were tumor size >7 cm (HR 0.12), collecting system invasion (HR 5.67), and tumor necrosis (HR 4.11) for OS (p < 0.05). In first-line sorafenib-treated patients, ≥4 metastatic lesions (HR 28.57), clinical T3-4 stage (HR 4.34), collecting system invasion (univariate analysis HR 2.11; multivariate analysis HR 0.07), lymphovascular invasion (HR 13.35), and tumor necrosis (HR 6.69) were significant prognosticators of PFS, as were bone metastasis (HR 5.49) and clinical T3-4 stages (HR 4.1) for OS (p < 0.05). Our study thus identified a number of primary tumor-related characteristics as important prognostic factors in sorafenib-treated mRCC patients.

Highlights

Up to one-third of patients with renal cell carcinoma (RCC) present with advanced disease globally, and 20–40% of those who undergo nephrectomy for localized RCC subsequently develop metastases [1]
Significant prognostic factors for progression-free survival (PFS) and overall survival (OS) were found on multivariate analysis
Clinical T3-4 stage was a negative predictor of PFS (Table 2), while collecting system invasion (HR 5.67, 95% CI 1.59–22.56) and tumor necrosis (HR 4.11, 95% CI 1.06–21.78) were negative predictors of OS (Table 3) (p < 0.05)

Summary

Introduction

Up to one-third of patients with renal cell carcinoma (RCC) present with advanced disease globally, and 20–40% of those who undergo nephrectomy for localized RCC subsequently develop metastases [1]. In the previous era of immunotherapy, the prognosis of patients with unresectable and/or metastatic RCC (mRCC) was dismal, and the average survival was approximately 12 months; only a fraction of patients (10– 20%) benefit from cytokine treatment because of limited therapeutic options and the resistance of RCC to conventional chemotherapy [2, 3]. Since 2005, a number of novel targeted therapy (TT) agents that show better efficacy for the treatment of advanced RCC, compared to previous immunochemotherapy agents, have been introduced, and the prognoses of advanced diseases such as mRCC have greatly improved. Prognoses vary widely, causing clinicians to question the predictive prognostic models of TTs in mRCCs. Various studies have attempted to stratify patients into poor, intermediate, and favorable prognosis groups by investigating multiple risk factors. Several predictive prognostic factors for TTs include laboratory findings, performance and immune status, physical condition, and tumor burden [6,7,8,9]

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