Analysis of the effect of clinical and laboratory parameters on survival in patients with metastatic renal cell cancer with intermediate prognosis according to IMDC (International mRCC Database Consortium)

Abstract

Introduction. Most patients with metastatic renal cell carcinoma (mRCC) who received systemic therapy are classified into as intermediate risk group according to the International mRCC Database Consortium (IMDC) assessment. However, survival differs in patients with one and two unfavourable prognostic risk factors.Objective. To analyze the impact of possible clinical and laboratory parameters on survival in mRCC patients with intermediate prognosis according to IMDC in the presence of one or two unfavourable prognostic risk factors.Materials & methods. A retrospective analysis of data from 316 mRCC patients with intermediate prognosis receiving systemic therapy was carried out. The presence and effect on survival of the following laboratory parameters were compared: hemoglobin, neutrophil count, LDH, platelet count, alkaline phosphatase, serum calcium level, ESR, and emphasis was also placed on the time of metastases appearance. Overall survival (OS), post-progression survival (PPS), and 3- and 5-year survival were evaluated.Results. The overall 3- and 5-year survival rate for subgroups with one and two unfavourable prognostic risk factors were 85.2%  ±  1.8% and 58.1  ±  1.6%; 79.1%  ±  1.7% and 35.6  1.6%, respectively (p < 0.001). Three- and 5-year PPS for both subgroups amounted to 66.1%  ±  1.6% and 21.8%  ±  1.4%; 45.2%  ±  1.5% and 12.2%  ±  1.3%, respectively (p < 0.001). Median for OS was 61 and 51 months and PPS was 50 and 32 months respectively (p <0.001). No statistically significant difference was found in the frequency of gradations of the investigated laboratory indicators with a predictive effect on prognosis, depending on the number of a unfavourable prognostic risk factors. There were also no significant differences in survival rates when laboratory parameters deviated from the normal, except for hemoglobin: OS in patients with one prognostic factor is significantly higher with normal hemoglobin (p < 0.05). In the future, considering the absence of influence of the selected factors on survival rates with their obvious significant differences in patients with one and two prognostic factors, the influence of the time of appearance of metastases (synchronous / metachronous) was analysed: all survival parameters were significantly worse in patients with synchronous metastases. Furthermore, OS in patients with metachronous metastases with the same relapse-free period was significantly better in patients with one prognostic factor according to IMDC.Conclusions. The presence of one or two prognostic factors significantly affects the indicators of 3 and 5-year overall survival and PPS in patients with an intermediate prognosis of mRCC, while laboratory parameters do not affect survival, except for hemoglobin levels, the time of metastases appearance has a significant effect, and the time of metastases appearance has a significant effect.