PROGNOSTIC INDICATORS FOR RESPONSE TO THERAPY AND SURVIVAL IN PATIENTS WITH METASTATIC RENAL-CELL CANCER TREATED WITH INTERFERON-ALPHA-2-BETA AND VINBLASTINE

Objectives. Only one third of all patients with metastatic renal cell carcinoma respond to immunochemotherapy. Improved patient selection co uld render such treatment unnecessary in many cases. The goal of the s tudy was to test various factors for their prognostic value as predict ors of success of immunochemotherapy and patient survival in metastati c renal cell carcinoma. Methods. Fifty patients with metastatic renal cell carcinoma were subjected to immunochemotherapy with interferon al pha-2 beta and vinblastine. Different variables such as age, sex, loca tion of metastasis, primary or late metastasis, performance status, hi stologic status, overexpression of the p53 protein and cell proliferat ion as assessed by immunohistochemistry, and deoxyribonucleic acid-plo idy were considered as potential prognostic factors for response to im munochemotherapy and survival. Results. Thirty percent (15) of the cas es responded to therapy: 2 complete and 15 partial remissions. In univ ariate analysis, the proliferative activity (Ki-S5 labeling index) eme rged as the statistically most significant prognostic factor (P = 0.00 13) for prediction of successful immunochemotherapy in metastatic rena l cell carcinoma. The second most significant factor was the location of metastases (P = 0.015), whereas all other parameters did not achiev e statistical significance, As to overall survival, responsiveness to therapy was the most significant predictor (P = 0.0003), followed by K i-S5 scores (P = 0.025). All other factors, including the sites of met astasic spread (P = 0.21), were not statistically relevant. Conclusion s. Proliferation status in terms of Ki-S5 immunoreactive scores appear s to be a valuable predictor of the responsiveness to immunochemothera py. Overall survival appears to depend essentially on disease progress ion and tumor cell proliferation. Other alleged prognostic factors, su ch as performance status, sarcomatoid histology, and metastasis locati on, were not significant in this study.