Factors That Influence Your Prognosis and Survival
Your survival with metastatic RCC can depend on tumor location, response to treatment, and other health conditions, says Jack Melson, MD, a medical oncologist at VCU Massey Comprehensive Cancer Center in Richmond, Virginia.
Overall Health
Other health issues may affect survival by changing what treatments you can have, says David Braun, MD, PhD, a medical oncologist and physician scientist at Yale Cancer Center in Connecticut.
On its own, pembrolizumab doesn’t affect blood pressure, but lenvatinib does. So depending on your personal health history, your provider may recommend a different combination.
Tumor Characteristics
Survival can change based on the type of RCC and tumor you have, says Dr. Braun.
- Type Clear cell renal cell carcinoma (the most common type) may carry a lower chance of survival than other types.
- Grade Providers grade tumors based on how their cells look under a microscope, and high-grade tumors are typically bigger and more aggressive.
- Dedifferentation Sometimes gene mutations prompt RCC cells to change into a more primitive cell type (like stem cells), which makes them more aggressive and harder to treat. This happens in about 5 to 8 percent of cases, depending on the cancer type.
- Necrosis When a tumor grows so fast that it causes cancer cell death (necrosis), that can point to an aggressive type with a lower survival rate.
Metastasis Locations
When cancer grows into other areas of the body (metastasizes), survival rates decrease, but where it spreads makes a difference, too, says Braun. “Areas like the liver, brain, and bone might indicate a more aggressive disease than metastasis to another site like the pancreas,” he says.
Risk Category
Cancer specialists use two systems to figure out your risk category, which helps predict your prognosis, says Dr. Melson:
- Memorial Sloan Kettering Cancer Center’s prediction tool
- International Metastatic Renal Cell Carcinoma Database Consortium’s risk calculator
These assessments look at the factors above to help care teams come up with an individualized survival time estimate. But they aren’t perfect, says Melson.
“One limitation of these models is that they do not clearly suggest how an oncologist should change treatment based on the calculated risk category,” says Melson, adding that experts are trying to develop tests that can help oncologists pick one treatment over another.
Response to Treatment
Response to treatment is a big factor in RCC survival, says Braun. Tumors can respond to treatment by shrinking, which improves survival time. “A tumor that is very responsive to a given therapy will likely lead to better outcomes,” he says.
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