Approximately one third of patients presenting with newly diagnosed RCC have metastatic disease.
Additionally, 20 – 40 % of patients with initially localised disease develop metastases.
Metastatic RCC has traditionally heralded a poor prognosis, with 10-year survival rates < 5 %.
Lung > nodes > bone > liver > adrenal > brain.
Prognostic guidance
The first prognostic scoring system was developed at MSKCC in the interferon era.
This work has been updated by IMDC using patients treated with TKIs and this IMDC (Heng) score has been well validated.
IMDC score can then be used to risk stratify into good, intermediate and poor risk groups.
| MSKCC | Karnofsky score < 80 %
< 1 year from diagnosis to systemic treatment
Hb < lower limit
Corrected calcium > 2.5 mmol / L
LDH > 1.5 x upper limit |
| IMDC (Heng) | Karnofsky < 80 %
< 1 year from diagnosis to systemic treatment
Hb < lower limit
Corrected calcium > upper limit
Neutrophils > upper limit
Platelets > upper limit |
 |
|
NB – patients presenting with de novo metastatic disease are automatically intermediate risk scoring 1 point.
Karnofsky:
- 80 = able to do normal work/activity but might have some signs/symptoms of disease
- 70 = able to care for self, but can’t do normal active work or activities