Abstract
ObjectivesTo investigate the necessity of stratifying patients in the intermediate-risk group of the Memorial Sloan Kettering Cancer Center (MSKCC) criteria in a real-world population of patients with metastatic renal cell carcinoma.Patients and MethodsWe retrospectively analyzed 234 consecutively treated patients who had received molecular targeted drugs. We examined the difference between progression-free survival and overall survival among patients in the intermediate-risk group of MSKCC criteria. We divided the intermediate group into two subgroups as follows: patients positive for only one risk factor (Int-1) and those positive for two risk factors (Int-2) including performance status, serum hemoglobin level, time from diagnosis to treatment, and corrected calcium and lactate dehydrogenase levels. Next, we evaluated the association between the number of metastatic organs, the presence of pancreatic metastasis, Int-1 or Int-2 grouping, and overall survival.ResultsThe median overall survival was 41.2 months. The median overall survival of the favorable-, intermediate-, and poor-risk groups of the MSKCC criteria were 91.0, 33.6, and 15.2 months, respectively. Patient characteristics were similar between the Int-1 and Int-2 groups. Increased positivity for risk factors of MSKCC classification between the two groups was for performance status and serum hemoglobin level. Progression-free survival and overall survival of the Int-1 group were significantly higher than those of the Int-2 group. In Cox proportional stepwise multivariate analysis, the Int-1 and Int-2 classification was an independent risk factor for overall survival.ConclusionPatients in the intermediate-risk group had different prognoses depending on the number of positive risk factors.
Highlights
The survival rate of patients with metastatic renal cell carcinoma has improved remarkably since the introduction of molecular targeted drugs [1,2,3,4]
Increased positivity for risk factors of Memorial Sloan Kettering Cancer Center (MSKCC) classification between the two groups was for performance status and serum hemoglobin level
Patients in the intermediate-risk group had different prognoses depending on the number of positive risk factors
Summary
The survival rate of patients with metastatic renal cell carcinoma has improved remarkably since the introduction of molecular targeted drugs [1,2,3,4]. The Memorial Sloan Kettering Cancer Center (MSKCC) risk classification is a survival risk classification advocated by Motzer et al [5] before treatment using molecular targeted drugs became common. International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk classification advocated by Heng et al [7] was established in the era of molecular targeted drugs and is used as widely as the MSKCC risk classification. There is another risk classification targeted for Japanese patients, which was remodeled to be used more practically by incorporating factors attributable to metastatic organs [8]
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