Validation of the MSKCC and Heng Risk Criteria Models for Predicting Survival in Patients with Metastatic Renal Cell Car
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ORIGINAL ARTICLE – UROLOGIC ONCOLOGY
Validation of the MSKCC and Heng Risk Criteria Models for Predicting Survival in Patients with Metastatic Renal Cell Carcinoma Treated with Sunitinib Whi-An Kwon, MD1,2, In-Chang Cho, MD3, Ami Yu, PhD4, Byung-Ho Nam, MD4, Jae Young Joung, MD5, Ho Kyung Seo, MD5, Kang Hyun Lee, MD5, and Jinsoo Chung, MD5 Department of Urology, Wonkwang University College of Medicine, Iksan, Republic of Korea; 2Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, Republic of Korea; 3Department of Urology, National Police Hospital, Seoul, Republic of Korea; 4Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea; 5Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Republic of Korea 1
ABSTRACT Purpose. To validate the Memorial Sloan-Kettering Cancer Center (MSKCC) and Heng models with metastatic renal cell carcinoma treated with sunitinib, and to investigate prognostic factors in these patients. Methods. This study included 106 patients with metastatic renal cell carcinoma who were treated with sunitinib from April 2007 to July 2012 including 35 patients who received systemic treatment before sunitinib and 71 that were naive to systemic treatment. Patients were evaluated using the MSKCC and Heng models, and the significance of several prognostic factors were evaluated. Results. The application of the MSKCC and Heng risk criteria resulted in stratification into 3 groups (favorable, intermediate, and poor risk) with distinctly different overall survival (OS) curves (P \ 0.001 and P \ 0.001, respectively), for the pretreated patients (P \ 0.001 and P \ 0.001, respectively). The Heng model had slightly better discriminatory ability (v2 = 30.82, Harrell’s C = 0.6895) than the MSKCC model (v2 = 25.13, Harrell’s C = 0.6532). Multivariate analysis revealed that the absence of nephrectomy and no hypertension at baseline, along with elevated C-reactive protein levels, were independent risk factors for poorer OS.
Ó Society of Surgical Oncology 2013 First Received: 14 June 2013; Published Online: 1 October 2013 J. Chung, MD e-mail: [email protected]
Conclusions. The MSKCC and Heng model were both valid models for predicting OS. The no nephrectomy, no hypertension at baseline, and high C-reactive protein levels were independently associated with poorer OS.
Renal cell carcinoma (RCC) is the third most common urinary tract malignancy and accounts for 3 % of all cancers in adults.1 The lack of an effective therapy for advanced disease means that RCC is the sixth leading cause of cancer death worldwide.2 The prognosis for patients with advanced disease remains poor, with 5-year survival rates below 20 %.3,4 Recent advances in our understanding of the biology of RCC, particularly the role of angiogenesis in the development and expansion of the tumor, have led to the development of novel targeted therapies, which are superior to treatment with interferon (IFN)-a.5–7 As the use of vascular endothe
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