MP14: Kidney Cancer: Advanced (including Drug Therapy) I
MP14-09: Differential risk stratification of Memorial Sloan Kettering Cancer Center (MSKCC) and the International Metastatic RCC Database Consortium (IMDC) prognostic score in patients with metastatic renal cell carcinoma (mRCC) treated with tyrosine-kinase inhibitors (TKI).
Friday, May 15, 2020
7:00 AM – 9:00 AM
Florian Janisch, Phillip Marks, Christian P. Meyer, Hang Yu, Constantin Fühner, Roland Dahlem, Mohammad Abufaraj, Shahrokh F. Shariat, Margit Fisch, Michael Rink
Introduction: Differential risk stratification between the MSKCC and the IMDC prognostic score represents a clinical challenge regarding treatment decision-making and subsequently may affect outcomes. We aimed to assess the extent of incongruence between MSKCC and IMDC score groups and its impact on survival in mRCC patients.
Methods: We collected and analyzed data of 262 mRCC patients treated with TKI therapy. MSKCC and IMDC were grouped according to disagreement between scores. Agreement between groups was tested with Cohen’s kappa. Descriptive analysis between the two groups as well as Kaplan-Meier estimates were used to assess the association of disagreement on overall (OS) and progression-free survival (PFS) as primary co-endpoints.
Results: Overall, there was agreement in 203 (77.5%) patients between both risk scores, with a Cohen’s kappa of 0.603 (p<0.01). Of 59 pts. with disagreement, 49 pts. (83%) were downgraded to lower, and 10 pts. (17%) upgraded to higher risk group from MSKCC to IMDC score. All up- or downgrading occurred from the intermediate to the good or poor prognosis groups. The most frequent, score-relevant factors involved in up- or downgrading were neutrophil leucocyte serum levels in 8 upgraded patients (80%) and LDH in 49 downgraded patients (100%), respectively. Patients with disagreement in prognostic risk scores had significantly worse MSKCC (p=0.03), better IMDC score groups (p<0.01), featured more often synchronous metastasis and a time to systematic therapy <1 year (p=0.01), and had more frequently a LDH =1.5 fold of the upper normal level (p=0.01). Before reclassification, there was a difference in outcome compared to the original data of Motzer et al. (2002), while afterwards, concordance was up to 95% to Heng et al. (2009).
Conclusions: A significant number of patients had disagreement between MSKCC and IMDC score groups in our analysis. According to our data, the IMDC score seems to represent the more accurate score in the TKI era, even in retrospective datasets. Source of