Identification of international metastatic renal cell carcinoma database consortium (IMDC) intermediate-risk subgroups in patients with metastatic clear-cell renal cell carcinoma
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Annalisa Guida1,2, Gwénaël Le Teuff3,4, Carolina Alves2, Emeline Colomba2, Vincenzo Di Nunno2, Lisa Derosa2,5, Ronan Flippot2, Bernard Escudier2 and Laurence Albiges2
1 University of Modena and Reggio Emilia, Modena, Italy
2 Department of Medical Oncology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, France
3 Service de Biostatistique et d'Épidémiologie, Gustave Roussy, Villejuif, France
4 CESP, Faculté de médecinec-Université Paris-Sud, Faculté de médecine - INSERM U1018, Université Paris-Saclay, Villejuif, France
5 INSERM U1015, Institute Gustave Roussy, Villejuif, France
Keywords: metastatic clear-cell renal cell carcinoma; IDMC; intermediate-risk; heterogeneous prognostic; platelets
Received: February 18, 2020 Accepted: August 17, 2020 Published: December 08, 2020
Majority of patients with clear-cell renal cell carcinoma (ccRCC) at first line (1L) treatment are classified in the intermediate-risk (IR) subgroup according to International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score. As these patients have different prognosis, the aim of this study is to better characterize IR patients in order to better tailor the treatment. Retrospective analysis was performed from IGReCC (Institut Gustave Roussy Renal Cell Carcinoma) database. Overall survival (OS) was defined from start of 1L therapy to death or last follow-up. A multivariable Cox model with backward selection procedure (α = 0.01) and a Classification and Regression Tree (CART) analysis were performed to identify which prognostic factors were associated to OS in IR patients.
From 2005 to 2017, 777 patients with ccRCC were treated with an anti-VEGF 1L therapy. Among 571 evaluable patients for IMDC score, 290 (51%) were classified as IR. With median follow-up 5.8 years (min: 0, max: 12.4) 212 deaths (73%) were observed and median OS was 25 months. Only platelet count was significantly associated to OS (hazard ratio 1.88 [95% CI 1.27–2.88] p = 0.0017). Median OS for patients with PLT > UNL was 18 months [95% CI 12–23] versus 29 months [95% CI 21.4–35.7] for patients with normal PLT count. The selection of PLT count was confirmed on bootstrap samples and was also selected for the first split of the CART-tree analysis.
Patients in the IR group have a heterogeneous prognosis. Elevated PLT count seems identifies a subgroup of patients with poor outcome in the IMDC intermediate-risk population with ccRCC.
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