Roberto Iacovelli1, Alessio Farcomeni2, Cora N Sternberg3, Giacomo Cartenì4, Michele Milella5, Matteo Santoni6, Linda Cerbone3, Giuseppe Di Lorenzo7, Elena Verzoni8, Cinzia Ortega9, Roberto Sabbatini10, Riccardo Ricotta11, Caterina Messina12, Vito Lorusso13, Francesco Atzori14, Fabio De Vincenzo15, Cosimo Sacco16, Francesco Boccardo17, Francesco Valduga18, Francesco Massari19, Valentina Baldazzi20, Saverio Cinieri21, Alessandra Mosca22, Enzo Maria Ruggeri23, Alfredo Berruti24, Giuseppe Procopio8. 1. Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: roberto.iacovelli@istitutotumori.mi.it. 2. Department of Public Health and Infectious Diseases, Sapienza-University of Rome, Rome, Italy. 3. Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy. 4. Oncology Unit, A. Cardarelli Hospital, Naples, Italy. 5. Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy. 6. Department of Medical Oncology, Polytechnic University of the Marche Region, Ancona, Italy. 7. Medical Oncology, Genitourinary Cancer Section, University Federico II, Naples, Italy. 8. Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 9. Fondazione del Piemonte per l'Oncologia IRCC, Candiolo, Italy. 10. Oncology Division, Department of Oncology and Hematology, University of Modena e Reggio Emilia, Modena, Italy. 11. Falck Division of Oncology, Ospedale Niguarda Ca' Granda, Milan, Italy. 12. Oncology Division, Ospedali Riuniti, Bergamo, Italy. 13. National Cancer Research Center, Istituto Tumori "Giovanni Paolo II", Bari, Italy. 14. Medical Oncology Unit, Azienda Ospedaliero Universitaria of Cagliari, Cagliari, Italy. 15. Oncology and Hematology Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy. 16. Oncology Unit, St Maria della Misericordia Hospital, Udine, Italy. 17. University and IRCCS AOU-San Martino-IST, National Cancer Research Institute, Genoa, Italy. 18. Medical Oncology, St. Chiara Hospital, Trento, Italy. 19. Medical Oncology, "G.B. Rossi" Academic Hospital, University of Verona, Verona, Italy. 20. Department of Medical Oncology; Santa Maria Annunziata Hospital, Florence, Italy. 21. Medical Oncology and Breast Unit Department, Sen A. Perrino Hospital, Brindisi, Italy. 22. Medical Oncology, Maggiore della Carità University Hospital, Novara, Italy. 23. Oncology Unit, Belcolle Hospital, Viterbo, Italy. 24. Medical Oncology, University of Brescia, Brescia, Italy.
Abstract
PURPOSE: Several prognostic models have been proposed for metastatic renal cell carcinoma but none has been validated in patients who receive third line targeted agents. We evaluated prognostic factors in patients with metastatic renal cell carcinoma who received a third line targeted agent. MATERIALS AND METHODS: We retrospectively reviewed data on 2,065 patients with clear cell metastatic renal cell carcinoma who were treated with targeted therapy at a total of 23 centers in Italy. Included in final analysis were 281 patients treated with 3 targeted agents. Overall survival was the main outcome. Cox proportional hazards regression followed by bootstrap validation was used to identify independent prognostic factors. RESULTS: Three clinical characteristics (ECOG performance status greater than 1, metastasis at diagnosis and liver metastasis) and 2 biochemical factors (hemoglobin less than the lower limit of normal and neutrophil count greater than the upper limit of normal, respectively) were prognostic. Patients were classified into 3 risk categories, including low-zero or 1, intermediate-2 and high risk-more than 2 risk factors. Median overall survival was 19.7, 10.1 and 5.5 months, and 1-year overall survival was 71%, 43% and 15%, respectively. The major limitation was the retrospective nature of this study and absent external validation. CONCLUSIONS: This nomogram included clinical and biochemical prognostic factors. In clinical trials it may be useful to select patients and define the prognosis.
PURPOSE: Several prognostic models have been proposed for metastatic renal cell carcinoma but none has been validated in patients who receive third line targeted agents. We evaluated prognostic factors in patients with metastatic renal cell carcinoma who received a third line targeted agent. MATERIALS AND METHODS: We retrospectively reviewed data on 2,065 patients with clear cell metastatic renal cell carcinoma who were treated with targeted therapy at a total of 23 centers in Italy. Included in final analysis were 281 patients treated with 3 targeted agents. Overall survival was the main outcome. Cox proportional hazards regression followed by bootstrap validation was used to identify independent prognostic factors. RESULTS: Three clinical characteristics (ECOG performance status greater than 1, metastasis at diagnosis and liver metastasis) and 2 biochemical factors (hemoglobin less than the lower limit of normal and neutrophil count greater than the upper limit of normal, respectively) were prognostic. Patients were classified into 3 risk categories, including low-zero or 1, intermediate-2 and high risk-more than 2 risk factors. Median overall survival was 19.7, 10.1 and 5.5 months, and 1-year overall survival was 71%, 43% and 15%, respectively. The major limitation was the retrospective nature of this study and absent external validation. CONCLUSIONS: This nomogram included clinical and biochemical prognostic factors. In clinical trials it may be useful to select patients and define the prognosis.