Survival prognosis following diagnosis of metastatic renal cell carcinoma: is performance status alone a sufficient predictor?


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Anna Street1,Hannah Copley1,Olivia Fraser1,Wojciech Cymes2,Athena Matakidou1,Tim Eisen1,Kate Fife1
1Addenbrooke's Hospital,2Addenbroooke's Hospital



Patients presenting with metastatic Renal Cell Carcinoma (RCC) have poor long term prognosis. A number of prognostic indicators are used to predict survival , including the Memorial  Sloan Kettering Cancer Centre[1] criteria and updated International Database Consortium [2] criteria, which stratify patients into risk groupsbased on laboratory values, time from diagnosis to treatment and performance status. Rather than a model based on additive risk factors, a single factor of direct clinical relevance is an appealing prospect. Here we assess whether World Health Organisation (WHO) performance status alone can adequately predict survival.


Patients presenting with metastatic RCC at a single institution were identified from a prospectively maintained database between October 2012 and August 2014. Median survival and Kaplan-Meier analysis by WHO status were performed.


939 patients presented with metastatic RCC during this time period. Exclusion criteria: localised disease only (n=58), WHO status not recorded (n=123) and inadequate follow up (n=84) were applied, leaving n=674 included. Performance status ranged from 0-4: 0 (44.4%), 1 (30.0%), 2 (15.9%), 1 (8.0%), 4 (1.5%). Median survival showed a step-wise reduction with higher WHO status (Survival in days, 95% confidence interval): 0 (1095, 936-1277), = 1 (521, 429-683), =2 (243, 159-357), =3 (129, 77-177), =4 (15, 14-92). Comparison of survival curves by WHO status demonstrated statistically significant difference (logrank, p<0001).


WHO performance status is a useful prognostic indicator when used independently. This may be particularly useful in resource-scarce environments including the developing world. The particularly poor prognosis seen in patients with WHO status or 3 and 4 may aid careful counselling and treatment decision making.