Open Access Highly Accessed Research article

Prognostic stratification of patients with advanced renal cell carcinoma treated with sunitinib: comparison with the Memorial Sloan-Kettering prognostic factors model

Aristotelis Bamias1*, Alexandra Karadimou1, Sofia Lampaki2, George Lainakis1, Lia Malettou3, Eleni Timotheadou2, Kostas Papazisis4, Charalambos Andreadis4, Loukas Kontovinis4, Ioannis Anastasiou5, Kostas Stravodimos5, Ioannis Xanthakis2, Andreas Skolarikos5, Christos Christodoulou6, Kostas Syrigos7, Christos Papandreou8, Evangelia Razi9, Urania Dafni3, George Fountzilas2 and Meletios A Dimopoulos1

Author Affiliations

1 Dept of Clinical Therapeutics, Athens University, Medical School, Athens, Greece

2 Department of Medical Oncology, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece

3 Data Office, Hellenic Cooperative Oncology Group, Athens, Greece

4 3rd Dept of Medical Oncology, Theagenion Cancer Hospital, Thessaloniki, Greece

5 Urology Dept, Athens University, Medical School, Athens, Greece

6 2nd Dept of Medical Oncology, Metropolitan Hospital, Athens, Greece

7 3rd Dept of Internal Medicine, University of Athens, Medical School, Athens, Greece

8 Dept of Medical Oncology, Larisa University Hospital, Larisa, Greece

9 1st Dept of Medical Oncology, Hygeia Hospital, Athens, Greece

For all author emails, please log on.

BMC Cancer 2010, 10:45  doi:10.1186/1471-2407-10-45

Published: 18 February 2010

Abstract

Background

The treatment paradigm in advanced renal cell carcinoma (RCC) has changed in the recent years. Sunitinib has been established as a new standard for first-line therapy. We studied the prognostic significance of baseline characteristics and we compared the risk stratification with the established Memorial Sloan Kettering Cancer Center (MSKCC) model.

Methods

This is a retrospective analysis of patients treated in six Greek Oncology Units of HECOG. Inclusion criteria were: advanced renal cell carcinoma not amenable to surgery and treatment with Sunitinib. Previous cytokine therapy but no targeted agents were allowed. Overall survival (OS) was the major end point. Significance of prognostic factors was evaluated with multivariate cox regression analysis. A model was developed to stratify patients according to risk.

Results

One hundred and nine patients were included. Median follow up has been 15.8 months and median OS 17.1 months (95% CI: 13.7-20.6). Time from diagnosis to the start of Sunitinib (<= 12 months vs. >12 months, p = 0.001), number of metastatic sites (1 vs. >1, p = 0.003) and performance status (PS) (<= 1 vs >1, p = 0.001) were independently associated with OS. Stratification in two risk groups ("low" risk: 0 or 1 risk factors; "high" risk: 2 or 3 risk factors) resulted in distinctly different OS (median not reached [NR] vs. 10.8 [95% confidence interval (CI): 8.3-13.3], p < 0.001). The application of the MSKCC risk criteria resulted in stratification into 3 groups (low and intermediate and poor risk) with distinctly different prognosis underlying its validity. Nevertheless, MSKCC model did not show an improved prognostic performance over the model developed by this analysis.

Conclusions

Studies on risk stratification of patients with advanced RCC treated with targeted therapies are warranted. Our results suggest that a simpler than the MSKCC model can be developed. Such models should be further validated.