Mekhail TM et al. (2005) Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma. J Clin Oncol 23: 832–841

In 2002, Motzer et al. proposed a prognostic model for survival in patients with previously untreated renal cell carcinoma, based on patient characteristics and biochemical parameters. In their recent study, Mekhail and colleagues from the Cleveland Clinic Foundation have validated the model and added two further prognostic factors.

The investigators analyzed the records of 308 patients with metastatic renal cell carcinoma who were included in clinical trials between 1987 and 2002. All patients were treated with immunotherapy and/or chemotherapy and most had prior nephrectomy. The team discovered that four of the five prognostic factors in the Motzer et al. model—time from diagnosis to treatment, hemoglobin, serum lactate dehydrogenase and corrected serum calcium—were independent predictors of survival in these patients. The corresponding favorable, intermediate and poor-risk groups had median survival times similar to those reported in Motzer et al.'s analysis.

Having considered an array of potential prognostic factors, Mekhail et al. showed that prior radiotherapy and the number of metastatic sites (none or one vs two or three) were also independent predictors of survival. The main effect of adding these two additional factors to the model was to reclassify some of the 'intermediate risk' patients into the favorable or poor-risk groups.

In conclusion, this study validates and extends the model proposed by Motzer et al. An international consortium has now been set up to continue the work and to agree a common approach.