転移性腎癌症例の予後因子の検討

Abstract

To identify prognostic factors for survival and risk classification in Japanese patients, we studied clinical parameters in 79 patients with metastatic renal cell carcinoma (mRCC) treatedat our institution from 1988 to 2004. Univariate andmultivariate analyses were performedto identify prognostic factors for survival. In univariate analysis, the absence of nephrectomy, metastasis at first visit, ECOG performance status (PS) 2 or more, liver metastasis, brain metastasis, low hemoglobin (<lower limit of normal), C-reactive protein (CRP) >0.3, and serum lactate dehydrogenase (LDH) higher than 1.5 times the upper normal limit were significantly associatedwith poor outcome. Multivariate analysis demonstratedthat two variables remained significant : hepatic metastasis andhigh LDH. Hepatic metastasis, high LDH, nephrectomy, metastasis at first visit, poor ECOG PS andCRP >0.3 were usedto categorize patients into three groups. The 2-year survival rate was 72.9% for the patients with no or one risk factor, 40.2% for those with two and15.1% for those with three or more. According to Motzer's criteria, the 2-year survival rates for patients with favorable risk, intermediate risk, andpoor risk were 85.1, 33.0, and13.1 % respectively. Our prognostic criteria are simple, andcan be usedto categorize Japanese patients with mRCC into three risk groups.