Multivariable Model Identifies Risk Stratification In Renal Cell Carcinoma

Prognostic factors associated with the overall survival (OS) in intermediate-risk (IR) patients of clear-cell renal cell carcinoma (ccRCC), can be identified using risk stratification models as per the study "Identification of international metastatic renal cell carcinoma database consortium (IMDC) intermediate-risk subgroups in patients with metastatic clear-cell renal cell carcinoma", published in the journal Oncotarget.

The clear-cell renal cell carcinoma (ccRCC) with first line (1L) treatment classifies majority of patients in the intermediate-risk (IR) subgroup as per the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score. With vivid heterogeneisty in their prognosis, the study team aims to better characterize IR patients for precise tailoring of the treatment.

‘Patients in the intermediate-risk (IR) group in clear-cell renal cell carcinoma (ccRCC), have a heterogeneous prognosis where elevated platelet count reflects the cancer-related inflammatory status. This helps formulate one of the most important challenges in mRCC that is, how prognostic stratification will guide front-line treatment selection and further explore optimal clinical trials design and stratification.’

They analyzed retrospective data from IGReCC (Institut Gustave Roussy Renal Cell Carcinoma) database using a multivariable Cox model with backward selection procedure and a Classification and Regression Tree Analysis (CART). And overall survival was defined from the start of 1L therapy to death or last follow-up.

There were 777 patients with ccRCC who underwent treatment with an anti-VEGF 1L therapy from 2005 to 2017. Among them, 571 patients who were evaluable for IMDC score, 290 (51%) were classified as IR. It was observed that elevated platelet (PLT) count identified a subgroup of patients with poor outcome in the IMDC intermediate-risk population with ccRCC.

The Multivariable Model

"The risk stratification models for metastatic renal cell carcinoma (mRCC) patients were developed as a clinical tool to guide counseling, to predict individual patient prognosis and also to design clinical trial", says Dr. Laurence Albiges from The Universit� Paris-Saclay.

Median OS for patients with PLT > UNL (upper normal level) was 18 months versus 29 months for patients with normal PLT count.

The study thereby states that the patients in the IR group have a heterogeneous prognosis where elevated platelet count reflects the cancer-related inflammatory status and seems to segregate patients with the worst prognosis in the intermediate-risk group.

This helps formulate one of the most important challenges in mRCC, that is, how prognostic stratification will guide front-line treatment selection and further explore optimal clinical trials design and stratification

Source: Medindia