Background: Renal cell carcinomas include several distinct entities with a range of biologic and clinical behavior from relatively indolent to extremely aggressive. Although conventional prognostic factors such as stage and grade are quite useful, other clinical, laboratory, and pathologic findings are now believed to have additional predictive value.
Methods: A review of the literature on the evaluation of prognostic factors in general and on the current status of prognostic factors in renal cell carcinoma in particular was undertaken. A working classification of prognostic factors, as recommended by the College of American Pathologists, was used. For clarity, the prognostic indicators were grouped according to whether each was a patient-related or tumor-related factor.
Results: Patient-related prognostic factors include symptomatic presentation, significant weight loss, poor performance status, anemia, hypercalcemia, elevated alkaline phosphatase and, perhaps, elevated serum ferritin. The most widely used tumor-related prognostic factors include stage, grade, and histologic type. Recently proposed biomarkers still under investigation include DNA content, as well as markers of cellular proliferation, apoptosis, and angiogenesis, among others.
Conclusions: Current prognostic factors for renal cell carcinoma yield considerable information for assisting with patient management and predicting clinical outcome. Traditional prognostic factors remain the most valuable, even though a variety of other patient-related and tumor-related factors may significantly contribute to prognostic information. A number of recently described biomarkers show great promise but the current data are insufficient to recommend their use.