Donskov and von der Maase identified prognostic factors for a patient with metastatic renal cell carcinoma. These can help distinguish patients with short from long-term survival. The authors are from Aarhus University in Denmark.
Patient selection:
(1) Karnofsky performance scale >= 70
(2) age 18 to 75 years
(3) absence of brain metastases
Parameters for clinical assessment:
(1) serum LDH
(2) lymph node metastases
(3) hemoglobin
(4) Karnofsky performance score (KPS)
(5) bone metastases
Parameters for immune response:
(1) absolute neutrophil count in the peripheral blood
(2) number of CD57 positive cells in the tumor (NK cells)
(3) neutrophil infiltrate in the tumor
|
Clinical Parameter |
Finding |
Points |
|
serum LDH |
normal |
0 |
|
|
> 1.5 times upper limit of normal |
1 |
|
lymph node metastases |
absent |
0 |
|
|
present |
1 |
|
hemoglobin |
normal |
0 |
|
|
anemia |
1 |
|
Karnofsky performance scale |
90 or 100 |
0 |
|
|
70 or 80 |
1 |
|
bone metastases |
absent |
0 |
|
|
present |
1 |
where:
• There is a gap in the serum LDH between the upper limit of normal and 1.5 times the upper limit.
total clinical score =
= SUM(points for all 5 clinical parameters)
|
Immunologic Parameter |
Finding |
Points |
|
absolute neutrophil count |
<= 6,000 per µL |
0 |
|
|
> 6,000 per µL |
1 |
|
intratumoral CD57 positive cells |
>= 50 per square mm |
0 |
|
|
< 50 per square mm |
1 |
|
neutrophil tumor infiltrate |
absent |
0 |
|
|
present |
1 |
total immunologic score =
= SUM(points for all 3 immunologic variables)
Interpretation:
• minimum scores: 0
• maximum clinical score: 5
• maximum immunologic score: 3
|
Clinical Score |
Immunologic Score |
Estimated 5 Year Survival |
Median Survival |
|
0, 1 or 2 |
0 |
60% |
> 72 months |
|
0, 1 or 2 |
1 |
25% |
19 months |
|
0, 1 or 2 |
2 or 3 |
0 |
13 months |
|
3, 4 or 5 |
NA |
0 |
7 months |
Specialty: Hematology Oncology, Surgery, general, Nephrology
ICD-10: ,
