Abstract
BackgroundThe association between performance status (PS) and the prognosis of metastatic renal cell carcinoma (mRCC) patients receiving tyrosine kinase inhibitors (TKIs) remains controversial. The aim of this study is to evaluate the prognostic value of PS in mRCC patients treated with TKIs.MethodsElectronic databases were searched to identify the studies that had assessed the association between pretreatment PS and prognosis in mRCC patients receiving TKIs. Hazard ratios (HRs) and 95% confidence interval (CI) for overall survival (OS) and progression-free survival (PFS) from eligible studies were used to calculate combined HRs. The heterogeneity across the included studies was assessed by Cochrane’s Q test and I2 statistic. The Begg’s funnel plot and Egger’s linear regression teats were used to evaluate the potential publication bias. The meta-analysis was performed with RevMan 5.3 and Stata SE12.0 according to the PRISMA guidelines.ResultsA total of 6780 patients from 19 studies were included in this meta-analysis. The results showed that a poor PS was an effective prognostic factor of both OS (pooled HR: 2.08, 95% CI: 1.78–2.45) and PFS (pooled HR: 1.51, 95% CI: 1.20–1.91). Subgroup analysis revealed that poor PS significantly associated with poor OS and PFS in studies using Karnofsky PS scale (OS, pooled HR: 2.20, 95% CI: 1.65–2.94; PFS, pooled HR: 1.74, 95% CI: 1.19–2.56), conducted in Asia (OS, pooled HR: 2.25, 95% CI: 1.71–2.95; PFS, pooled HR: 1.73, 95% CI: 1.14–2.64) and Newcastle-Ottawa Scale score of 8 (OS, pooled HR: 2.61, 95% CI: 1.92–3.55; PFS, pooled HR: 2.43, 95% CI: 1.36–4.33).ConclusionsThis study suggests that a poor PS is significantly associated with poor prognosis in mRCC patients receiving TKIs.
Highlights
The association between performance status (PS) and the prognosis of metastatic renal cell carcinoma patients receiving tyrosine kinase inhibitors (TKIs) remains controversial
After assessing the full text of the remaining 64 articles, 45 articles were excluded for some specific reasons, including not TKI treatment, not evaluate the association between PS and survival outcome, involving other targeted therapies, not available hazard ratio, duplicate data and not English articles
The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) [19] and Memorial Sloan-Kettering Cancer Center (MSKCC) [17] risk models are being used to predict the prognosis of metastatic renal cell carcinoma (mRCC) patients, PS is expected to be a simpler indictor for screening of mRCC patients who received TKIs in clinical practice
Summary
The association between performance status (PS) and the prognosis of metastatic renal cell carcinoma (mRCC) patients receiving tyrosine kinase inhibitors (TKIs) remains controversial. The aim of this study is to evaluate the prognostic value of PS in mRCC patients treated with TKIs. Renal cell carcinoma (RCC) is the most common cancer of kidney in adults [1]. Performance status (PS) is used to quantify quickly the general well-being of people with illness and their ability to perform activities of daily living [10] It is usually a proxy measure estimated by clinician and influences the decision to apply treatment regiments [11,12,13].
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