Akademik Veri Yönetim Sistemi
European Urology, Supplements, cilt.8, sa.5, ss.478-482, 2009 (SCI-Expanded)
Context: For many years, cytokines have been utilised in treatment of metastatic renal cell carcinoma (mRCC), with limited response rates and significant side-effects. Recently, several targeted agents have demonstrated clinical efficacy in the treatment of mRCC. Objective: To discuss the applicability of previously described prognostic factors in patients with mRCC who are starting targeted therapy. Evidence acquisition: Clinical data on prognostic factors and patient stratification strategies are reviewed. Evidence synthesis: During the cytokine era, time from diagnosis to treatment, Karnofsky performance status (PS), serum lactate dehydrogenase, corrected serum calcium, and haemoglobin were the identified prognostic factors, and risk group stratifications derived from these criteria represent a standard. In contrast, the results of some studies during the targeted therapy era revealed that prognostic factors and models that were described prior to the availability of novel agents may not be entirely applicable to patients with mRCC who are starting vascular endothelial growth factor (VEGF)-targeted therapy. This is important because many trials evaluating these novel agents have stratified patients using outdated models from the cytokine era. More recent prognostication models include nomograms, and they are designed to individualise therapy to improve clinical efficacy. Conclusions: Prognostic factors and patient stratification strategies for the treatment of mRCC are reviewed in the context of available clinical data. Development of reliable prognostication models or nomograms requires reassessment of clinical and biologic features of mRCC patients that are predictive of outcome. © 2008 European Association of Urology.