Consortium database model compares favorably for RCC prognosis

By Lucy Piper, Senior medwireNews Reporter

The International Metastatic Renal-Cell Carcinoma (RCC) Database has been externally validated and is now ready for application, researchers report.

This prognostic model can be used to "stratify patients by risk in clinical trials and to counsel patients about prognosis," say Daniel Heng (Tom Baker Cancer Center, Calgary, Alberta, Canada) and colleagues, and "might be better than others with respect to ease of use and stratification capability."

Complete medical data available for 849 patients with metastatic renal cell carcinoma who were treated with first-line vascular endothelial growth factor-targeted treatment were used to assess the Database Consortium model and data for 627 patients were used to compare its performance with existing prognostic models.

The six risk factors used in the Database Consortium model - anemia, thrombocytosis, neutrophilia, hypercalcemia, Karnofsky performance status below 80%, and less than 1 year from diagnosis to treatment - independently predicted poor overall survival with hazard ratios ranging from 1.27 to 2.08.

Stratification of the patients according to risk placed 18% of patients in the favorable risk group, 52% in the intermediate risk group, and 30% in the poor risk group.

Median overall survival times for these patients were 43.2 months, 22.5 months, and 7.8 months, respectively.

This risk stratification result was very similar to that for four commonly used prognostic models - the Memorial Sloan-Kettering Cancer Center (MSKCC) model, the Cleveland Clinic Foundation (CCF) model, the French model, and the International Kidney Cancer Working group (IKCWG) model.

Concordance rates for the Database Consortium were high, at 83% with the MSKCC model, 64% with the CCF model, 61% with the French model, and 69% with the IKCWG model.

Also, the reported 2-year death rate for the patients was closest to that predicted by the Database Consortium model.

The researchers note in TheLancet Oncology that the similarity between the Database Consortium model and existing models, shows a possible "ceiling in prognosis" effect using clinical variables alone.

Matthew Galsky, from Mount Sinai School of Medicine in New York, USA, suggests in a related commentary that "the inclusion of new molecular pathological and clinical variables in the Database Consortium model could help to overcome the current generation of prognostic models."

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