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Simple Summary
Despite the continuous therapeutic efforts metastatic renal cell carcinoma (mRCC) is a dreadful disease, but the many options available provide an horizon of hope for these patients. Sequential therapy based on vascular endothelial growth factor-tyrosine kinase inhibitors (VEGFR-TKI) continues in use. We present a nomogram for a more individualized and accurate estimation of cancer-specific survival (CSS) for patients with clear-cell (CC) mRCC treated with nephrectomy and VEGFR-TK, based on four independent clinical predictors: Eastern Cooperative Oncology Group (ECOG) status; International Metastatic RCC Database Consortium (IMDC) score; Morphology, Attenuation, Size and Structure (MASS) and Response Evaluation Criteria in Solid Tumors (RECIST) response criteria. This tool may be useful to clinicians assessing risk and prognosis of patients with mRCC.
Abstract(1) Objective: To develop a clinically useful nomogram that may provide a more individualized and accurate estimation of cancer-specific survival (CSS) for patients with clear-cell (CC) metastatic renal cell carcinoma (mRCC) treated with nephrectomy and vascular endothelial growth factor receptor–tyrosine kinase inhibitor (VEGFR-TKI)-based sequential therapy. (2) Methods: A prospectively maintained database of 145 patients with mRCC treated between 2008 and 2018 was analyzed to predict the CSS of patients receiving sunitinib and second- and third-line therapies according to current standards of practice. A nomogram based on four independent clinical predictors (Eastern Cooperative Oncology Group status, International Metastatic RCC Database Consortium score, the Morphology, Attenuation, Size and Structure criteria and Response Evaluation Criteria in Solid Tumors response criteria) was calculated. The corresponding 1- to 10-year CSS probabilities were then determined from the nomogram. (3) Results: The median age was 60 years (95% CI 57.9–61.4). The disease was metastatic at diagnosis in 59 (40.7%), and 86 (59.3%) developed metastasis during follow-up. Patients were followed for a median 48 (IQR 72; 95% CI 56–75.7) months after first-line VEGFR-TKI initiation. The concordance probability estimator value for the nomogram is 0.778 ± 0.02 (mean ± SE). (4) Conclusions: A nomogram to predict CSS in patients with CC mRCC that incorporates patient status, clinical risk classification and response criteria to first-line VEGFR-TKI at 3 months is presented. This new tool may be useful to clinicians assessing the risk and prognosis of patients with mRCC.
Details
Patients;
Kidney cancer;
Medical prognosis;
Metastasis;
Immunotherapy;
Vascular endothelial growth factor;
Vascular endothelial growth factor receptors;
Cancer therapies;
Prognosis;
Classification;
Oncology;
Solid tumors;
Consortia;
Nephrectomy;
Tyrosine kinase inhibitors;
Metastases;
Nomograms;
Renal cell carcinoma;
Morphology;
Statistical analysis
; Larrinaga, Gorka 2
; Lecumberri, David 3 ; Iturregui, Ane Miren 3
; Jon Danel Solano-Iturri 4 ; Lawrie, Charles H 5
; Armesto, María 6
; Dorado, Juan F 7 ; Nunes-Xavier, Caroline E 8
; Pulido, Rafael 9
; Manini, Claudia 10
; López, José I 11
1 Clinical Department, Faculty of Medical Sciences, European University of Madrid, 28905 Getafe, Spain
2 Biobizkaia Health Research Institute, 48903 Barakaldo, Spain;
3 Department of Urology, Urduliz University Hospital, 48610 Urduliz, Spain;
4 Pathology Department, Cruces University Hospital, 48903 Barakaldo, Spain;
5 Molecular Oncology Group, Biogipuzkoa Health Research Institute, 20014 San Sebastián, Spain;
6 Molecular Oncology Group, Biogipuzkoa Health Research Institute, 20014 San Sebastián, Spain;
7 PeRTICA Statistical Solutions, Plaza de la Constitución, 2, 28943 Fuenlabrada, Spain;
8 Biobizkaia Health Research Institute, 48903 Barakaldo, Spain;
9 Biobizkaia Health Research Institute, 48903 Barakaldo, Spain;
10 Pathology Department, S. Giovanni Bosco Hospital, 10154 Turin, Italy;
11 Biobizkaia Health Research Institute, 48903 Barakaldo, Spain;