Prognostic factors in metastatic renal carcinoma.

We reviewed 181 cases of metastatic renal carcinoma treated from 1973 to 1982 to characterize the factors associated with prolonged survival. Cumulative survival from the date of first known metastasis was analyzed with respect to the patient age, sex, interval free of disease, performance status, site of metastasis and nephrectomy. Survival for the entire group was 73 per cent at 6 months, 48 per cent at 1 year and 9 per cent at 5 years. Age and sex did not influence survival. Improved survival was correlated with long interval free of disease between nephrectomy and discovery of metastases, normal performance status, metastases limited to the lung parenchyma and removal of the primary tumor. The effect of nephrectomy on survival was not separable from effects of patient selection. The subgroup of patients with the favorable characteristics had longer survival than was reported previously for advanced renal carcinoma (50 per cent at 3 years, median 24 months). These patients may be appropriate candidates for more aggressive therapy. These factors should be considered in the analysis of results of future clinical trials on metastatic renal carcinoma.