Metastatic renal cell cancer and radical nephrectomy: identification of prognostic factors and patient survival.

Between January 1, 1970 and December 31, 1980 (followup 2 years or more) 158 patients with histologically proved metastatic renal cell cancer and no prior therapy were seen. Statistical analyses identified variables that significantly influenced survival, including grade of the primary lesion (p equals 0.002), weight loss of more than 10 per cent (p less than 0.0001) and multiple versus single metastases (p equals 0.0001). Cell type, soft tissue versus bone metastasis, age, sex, site and size of primary lesion, and delay in the diagnosis did not influence survival significantly. Adjuvant nephrectomy markedly influenced survival only in patients with solitary metastasis, low grade primary tumor and weight loss of less than 10 per cent (p equals 0.06). Based on this analysis a score system was constructed to help predict survival and the impact of new forms of therapy in the future.