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1788 EXPRESSION LEVEL OF VASCULAR ENDOTHELIAL GROWTH FACTOR RECEPTOR-2 IN RADICAL NEPHRECTOMY SPECIMENS AS A PROGNOSTIC PREDICTOR IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA TREATED WITH SUNITINIB
Vol. 187, No. 4S, Supplement, Tuesday, May 22, 2012
Univariate analysis HR [CI] Age ⬎60years
0.76 [0.46-1.27]
Gender
1.06 [0.63-1.79]
Race
1.87 [0.94-3.70]
ASA class
1.15 [0.40-3.27]
Left vs. right sided
1.24 [0.69-2.23]
THE JOURNAL OF UROLOGY姞
Multivariate analysis HR [CI]
Level of thrombus RV only
referent
IVC below diaphragm
1.50 [1.02-2.22]
IVC above diaphragm
2.06 [1.07-3.97]
1.59 [0.69-3.65]
Path tumor size ⬎9cm
2.21 [1.26-3.89]
1.85 [1.16-2.95]
Sarcomatoid features
0.79 [0.25-2.53]
Fuhrman grade 4
1.22 [0.70-2.11]
Renal sinus fat invasion
1.44 [0.86-2.42]
1.14 [0.69-1.87]
Peripheral fat invasion
1.74 [1.04-2.90]
1.48 [0.94-2.32]
Non-clear cell pathology
2.28 [1.21-4.33]
2.98 [1.56-5.69]
Surgery after 2003
0.85 [0.51-1.43]
Source of Funding: None
1786 C-REACTIVE PROTEIN AS A MARKER OF TREATMENT RESPONSE AND PREDICTOR OF PROGNOSIS IN CHINESE METASTATIC RENAL CELL CARCINOMA PATIENTS TREATED WITH SUNITINIB guohai shi*, SHANGHAI, China, People’s Republic of INTRODUCTION AND OBJECTIVES: We designed the present study to evaluate the prognostic value of CRP for mRCC patients treated with sunitinib. METHODS: Sunitinib was given to 90 patients with clear cell mRCC. Serum CRP was tested before treatment and every 4 weeks after first administration of sunitinib. Oncological evaluation was carried out every 6 weeks. Kaplan¨ CMeier and Cox regression analyses on progression-free survival (PFS) were carried out. Patients were divided into three groups according to CRP kinetics. Normal values of CRP levels were considered less than 0.5 mg/dl. Patients whose pretreatment CRP levels were less than 0.5 mg/dl, patients whose (less than 0.5 mg/dl) at least one time during treatment, and patients whose pretreatment CRP levels were higher than 0.5 mg/dl and never normalized CRP group, and non-normalized CRP group, respectively. RESULTS: During the median 26 months of follow up (range 12-46 months), baseline CRP levels ranged from 3 to 86 mg/dl. Dividing the cohort into three groups according to CRP kinetics status, median PFS was 25 months in the decreased CRP group, 12.4 months in the stable CRP group and 5 months in the increased CRP group. Performance status, time from diagnoses to sunitinib treatment, number of metastatic organs and CRP kinetics were independent predictors for PFS in multivariable Cox regression model analysis, with an area under the curve of 0.865 in a binary logistic regression model of 12-month PFS probability. CONCLUSIONS: CRP kinetics can be useful to monitor the treatment response and to predict PFS for mRCC patients treated with sunitinib therapy. Source of Funding: None
e721
1787 THE EFFECT OF NODAL CODING SCHEMES ON CANCER-SPECIFIC MORTALITY AFTER CYTOREDUCTIVE NEPHRECTOMY Quoc-Dien Trinh*, Detroit, MI; Jan Schmitges, Hamburg, Germany; Jesse D Sammon, Khurshid R Ghani, Detroit, MI; Maxine Sun, Montreal, Canada; Jens Hansen, Hamburg, Germany; Wooju Jeong, Detroit, MI; Marco Bianchi, Montreal, Canada; Jay Jhaveri, Shyam Sukumar, Detroit, MI; Paul Perrotte, Claudio Jeldres, Montreal, Canada; Piyush K Agarwal, Craig G Rogers, James O Peabody, Detroit, MI; Shahrokh F Shariat, New York, NY; Mani Menon, Detroit, MI; Pierre I Karakiewicz, Montreal, Canada INTRODUCTION AND OBJECTIVES: Relatively few reports have described the outcomes of patients with node-positive renal cell carcinoma (RCC) in the presence of distant metastases. We examined the outcomes of these patients in a large population-based cohort of patients and examined the ability of standard risk factors to predict cancer-specific mortality (CSM). METHODS: Using the Surveillance, Epidemiology, and End Results database, a total of 619 RCC patients with nodal and distant metastases undergoing cytoreductive nephrectomy were identified. Univariable and multivariable analyses addressed CSM with the intent of identifying independent predictors of CSM in this cohort of patients. Specifically, we examined the effect of the number of removed nodes (NRN), the number of positive nodes (NPN) and the percentage of positive nodes (PPN) on CSM. RESULTS: Actuarial survival estimates demonstrated that 40.2, 23.5 and 11.5% of patients survived at 12, 24 and 60 months after nephrectomy. In Kaplan-Meier analyses, NRN failed to clearly discriminate between recorded CSM rates (log rank p⫽0.9). Discrimination was noted when CSM was stratified according to NPN (log rank p⫽0.002) and PPN (log rank p⫽0.003). In multivariable analyses, year of diagnosis, histological subtype and PPN were independent predictors of CSM. CONCLUSIONS: Our data indicate that PPN is an independent predictor of CSM in patients with nodal and distant metastases undergoing cytoreductive nephrectomy. Consequently, PPN warrants consideration in future prognostic schemes. Source of Funding: None
1788 EXPRESSION LEVEL OF VASCULAR ENDOTHELIAL GROWTH FACTOR RECEPTOR-2 IN RADICAL NEPHRECTOMY SPECIMENS AS A PROGNOSTIC PREDICTOR IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA TREATED WITH SUNITINIB Tomoaki Terakawa*, Akashi, Japan; Hideaki Miyake, Yuji Kusuda, Masato Fujisawa, Kobe, Japan INTRODUCTION AND OBJECTIVES: Sunitinib, an orally available inhibitor of multiple tyrosine kinases, has been one of the most widely used molecular-targeted agents against renal cell carcinoma (RCC). To date, several model systems predicting the prognosis of patients with metastatic RCC have been reported; however, these prognostic profiles were developed based on data from patients who mainly participated in clinical trials using cytokine therapies; therefore, in the era of molecular-targeted therapies, it would be important to identify novel variables associated with susceptibility to these agents in order to provide individualized risk-directed therapy for patients with metastatic RCC. The objective of this study was to investigate the expression levels of multiple molecular markers in radical nephrectomy specimens from patients with metastatic RCC treated with sunitinib in addition to conventional clinicopathological parameters in order to identify factors predicting the prognosis in these patients. METHODS: This study included 60 consecutive patients undergoing radical nephrectomy, who were diagnosed as having metastatic RCC and subsequently treated with sunitinib. Expression levels of 10
e722
THE JOURNAL OF UROLOGY姞
molecular markers, including Bcl-2, Bcl-xL, Bax, phosphorylated Akt, p44/42 mitogen-activated protein kinase (MAPK) and signal transducers and activation of transcription 3 (STAT3), vascular endothelial growth factor receptor (VEGFR)-1 and -2, and platelet-derived growth factor receptor (PDGFR)-␣ and -, in primary RCC specimens were measured by immunohistochemical staining. RESULTS: Of several factors examined, tumor grade and the expression level of VEGFR-2 were shown to have significant impact on response to sunitinib in these 60 patients. Progression-free survival (PFS) was significantly associated with the expression levels of VEGFR-2 in addition to tumor grade, performance status, MSKCC risk classification system and c-reactive protein level on univariate analysis. Of these significant factors, only VEGFR-2 expression appeared to be independently related to PFS by multivariate analysis. In fact, the PFS in patients with strong expression of VEGFR-2 was significantly favorable compared with that in those with weak expression of VEGFR-2. CONCLUSIONS: It would be useful to consider expression levels of potential molecular markers, particularly VEGFR-2, as well as conventional parameters to select metastatic RCC patients likely to benefit from treatment with sunitinib. Source of Funding: None
1789 PREDICTION OF TKI-THERAPY RESPONSE IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA BY SERUM PROTEOMICS Martina Walter, Jena, Germany; Attila Szendroi, Budapest, Hungary; Nils Kroeger, Christian Bode, Jena, Germany; Thomas Steiner, ERfurt, Germany; Olaf Kniemeyer, Peter Zipfel, Jena, Germany; Imre Romics, Budapest, Hungary; Marc-Oliver Grimm, Kerstin Junker*, Jena, Germany INTRODUCTION AND OBJECTIVES: Several drugs are available for the treatment of metastatic Renal Cell Carcinoma (mRCC). The tyrosine kinase inhibitors (TKIs) Sunitinib and Sorafenib are two therapy options. Both agents lead to primary clinical benefit in the majority of patients while some others show no response and undergo progressive disease. Recognition of these patients would optimize individual treatment and also avoid high costs for health care system. For this reason reliable predictive biomarkers are necessary. The aim of this study is to establish protein signatures predictive for primary therapy response to Sunitinib and Sorafenib. METHODS: We examined serum samples from mRCC-patients before TKI-therapy and after 3 months (26 Sunitinib, 23 Sorafenib). Primary response after 3 months was evaluated by RECIST. Surface-enhanced laser desorption/ionisation time-of-flight mass spectrometry (SELDI-TOF MS) and multiplex two-dimensional fluorescence gel electrophoresis (Multiplex-2DE) were used separating samples into primary clinical benefit (CB) and primary progressive disease (PD). Identification of candidate proteins was performed by peptide mass fingerprinting (PMF). Western Blot and ELISA were carried out for quantification. RESULTS: Protein pattern specific for primary PD could be generated by SELDI-TOF MS and biostatistics. Multiplex-2DE revealed several differentially expressed proteins including serum amyloid A (SAA). Pre-therapeutic SAA-concentrations were significantly different between CB and PD in Sunitinib-treated patients. Comparison of therapeutic SAA-concentrations after 3 months resulted in significant differences for both Sunitinib and Sorafenib. High SAA-levels are representative for primary PD. CONCLUSIONS: Our data show that pre-therapeutic serum is well-suited to establish protein signatures for TKI-therapy response prediction based on the used techniques. Selection of patients for individual therapy seems possible. In this ongoing study further candidates from the detected protein signature have to be identified and validated on an independent patient cohort. Source of Funding: Research grant by Bayer
Vol. 187, No. 4S, Supplement, Tuesday, May 22, 2012
1790 CLINICAL RISK CLASSIFICATION SCORE IN PATIENTS AMENABLE FOR METASTASECTOMY FROM ADVANCED RENAL CELL CARCINOMA Lorenzo Tosco*, Udine, Italy; Hendrik Van Poppel, Leuven, Belgium; Bruno Frea, Udine, Italy; Steven Joniau, Leuven, Belgium INTRODUCTION AND OBJECTIVES: At present, standardized criteria for metastasectomy indication do not exist in patients with advanced renal cell carcinoma (RCC). The present analysis aimed to study clinical prognostic factors in a population of patients treated with nephrectomy or partial nephrectomy at baseline and with at least one surgical resection of metastases. Statistically significant prognostic factors were used to create a novel clinical score. We tested the potential of this score to predict survival rates of patients amenable for metastasectomy. METHODS: 117 consecutive patients were retrospectively studied. All patients underwent prior radical or partial nephrectomy for RCC. Metastasectomies from different anatomical sites were performed, with the main intent to completely resect the lesions even when multiple or synchronous. 14 patients (12%) were lost to follow-up. A multivariable Cox model was used to study the predictive power of different pre-treatment clinical factors. Alpha was set at 0.05. MedCalc® was used for all statistical analyses. RESULTS: Primary T stage ⬎ 3 and Fuhrman grade ⬎ 3 at nephrectomy, DFI (disease free interval) ⬍12 months, the presence of multiple-organ metastases and clinical evidence of non-pulmonary metastases were clinical independent prognostic factors at multivariate analysis Table 1. Those factors were used to obtain a score, ranging from 0 to 5 points. Four different prognostic groups were created: Group A (0-1 point), group B (2 points), group C (3 points) and group D (4-5 points). The results of the Kaplan Meier analysis with Log Rank test, based on these prognostic groups are shown on Fig. 1 (P⬍0,0001). CONCLUSIONS: The present pre-treatment clinical prognostic score has demonstrated to predict survival of patients previously treated with nephrectomy and amenable for metastasectomy. External validation is required to confirm our findings.
Univariate analysis HR [CI] Age ⬎60years
0.76 [0.46-1.27]
Gender
1.06 [0.63-1.79]
Race
1.87 [0.94-3.70]
ASA class
1.15 [0.40-3.27]
Left vs. right sided
1.24 [0.69-2.23]
THE JOURNAL OF UROLOGY姞
Multivariate analysis HR [CI]
Level of thrombus RV only
referent
IVC below diaphragm
1.50 [1.02-2.22]
IVC above diaphragm
2.06 [1.07-3.97]
1.59 [0.69-3.65]
Path tumor size ⬎9cm
2.21 [1.26-3.89]
1.85 [1.16-2.95]
Sarcomatoid features
0.79 [0.25-2.53]
Fuhrman grade 4
1.22 [0.70-2.11]
Renal sinus fat invasion
1.44 [0.86-2.42]
1.14 [0.69-1.87]
Peripheral fat invasion
1.74 [1.04-2.90]
1.48 [0.94-2.32]
Non-clear cell pathology
2.28 [1.21-4.33]
2.98 [1.56-5.69]
Surgery after 2003
0.85 [0.51-1.43]
Source of Funding: None
1786 C-REACTIVE PROTEIN AS A MARKER OF TREATMENT RESPONSE AND PREDICTOR OF PROGNOSIS IN CHINESE METASTATIC RENAL CELL CARCINOMA PATIENTS TREATED WITH SUNITINIB guohai shi*, SHANGHAI, China, People’s Republic of INTRODUCTION AND OBJECTIVES: We designed the present study to evaluate the prognostic value of CRP for mRCC patients treated with sunitinib. METHODS: Sunitinib was given to 90 patients with clear cell mRCC. Serum CRP was tested before treatment and every 4 weeks after first administration of sunitinib. Oncological evaluation was carried out every 6 weeks. Kaplan¨ CMeier and Cox regression analyses on progression-free survival (PFS) were carried out. Patients were divided into three groups according to CRP kinetics. Normal values of CRP levels were considered less than 0.5 mg/dl. Patients whose pretreatment CRP levels were less than 0.5 mg/dl, patients whose (less than 0.5 mg/dl) at least one time during treatment, and patients whose pretreatment CRP levels were higher than 0.5 mg/dl and never normalized CRP group, and non-normalized CRP group, respectively. RESULTS: During the median 26 months of follow up (range 12-46 months), baseline CRP levels ranged from 3 to 86 mg/dl. Dividing the cohort into three groups according to CRP kinetics status, median PFS was 25 months in the decreased CRP group, 12.4 months in the stable CRP group and 5 months in the increased CRP group. Performance status, time from diagnoses to sunitinib treatment, number of metastatic organs and CRP kinetics were independent predictors for PFS in multivariable Cox regression model analysis, with an area under the curve of 0.865 in a binary logistic regression model of 12-month PFS probability. CONCLUSIONS: CRP kinetics can be useful to monitor the treatment response and to predict PFS for mRCC patients treated with sunitinib therapy. Source of Funding: None
e721
1787 THE EFFECT OF NODAL CODING SCHEMES ON CANCER-SPECIFIC MORTALITY AFTER CYTOREDUCTIVE NEPHRECTOMY Quoc-Dien Trinh*, Detroit, MI; Jan Schmitges, Hamburg, Germany; Jesse D Sammon, Khurshid R Ghani, Detroit, MI; Maxine Sun, Montreal, Canada; Jens Hansen, Hamburg, Germany; Wooju Jeong, Detroit, MI; Marco Bianchi, Montreal, Canada; Jay Jhaveri, Shyam Sukumar, Detroit, MI; Paul Perrotte, Claudio Jeldres, Montreal, Canada; Piyush K Agarwal, Craig G Rogers, James O Peabody, Detroit, MI; Shahrokh F Shariat, New York, NY; Mani Menon, Detroit, MI; Pierre I Karakiewicz, Montreal, Canada INTRODUCTION AND OBJECTIVES: Relatively few reports have described the outcomes of patients with node-positive renal cell carcinoma (RCC) in the presence of distant metastases. We examined the outcomes of these patients in a large population-based cohort of patients and examined the ability of standard risk factors to predict cancer-specific mortality (CSM). METHODS: Using the Surveillance, Epidemiology, and End Results database, a total of 619 RCC patients with nodal and distant metastases undergoing cytoreductive nephrectomy were identified. Univariable and multivariable analyses addressed CSM with the intent of identifying independent predictors of CSM in this cohort of patients. Specifically, we examined the effect of the number of removed nodes (NRN), the number of positive nodes (NPN) and the percentage of positive nodes (PPN) on CSM. RESULTS: Actuarial survival estimates demonstrated that 40.2, 23.5 and 11.5% of patients survived at 12, 24 and 60 months after nephrectomy. In Kaplan-Meier analyses, NRN failed to clearly discriminate between recorded CSM rates (log rank p⫽0.9). Discrimination was noted when CSM was stratified according to NPN (log rank p⫽0.002) and PPN (log rank p⫽0.003). In multivariable analyses, year of diagnosis, histological subtype and PPN were independent predictors of CSM. CONCLUSIONS: Our data indicate that PPN is an independent predictor of CSM in patients with nodal and distant metastases undergoing cytoreductive nephrectomy. Consequently, PPN warrants consideration in future prognostic schemes. Source of Funding: None
1788 EXPRESSION LEVEL OF VASCULAR ENDOTHELIAL GROWTH FACTOR RECEPTOR-2 IN RADICAL NEPHRECTOMY SPECIMENS AS A PROGNOSTIC PREDICTOR IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA TREATED WITH SUNITINIB Tomoaki Terakawa*, Akashi, Japan; Hideaki Miyake, Yuji Kusuda, Masato Fujisawa, Kobe, Japan INTRODUCTION AND OBJECTIVES: Sunitinib, an orally available inhibitor of multiple tyrosine kinases, has been one of the most widely used molecular-targeted agents against renal cell carcinoma (RCC). To date, several model systems predicting the prognosis of patients with metastatic RCC have been reported; however, these prognostic profiles were developed based on data from patients who mainly participated in clinical trials using cytokine therapies; therefore, in the era of molecular-targeted therapies, it would be important to identify novel variables associated with susceptibility to these agents in order to provide individualized risk-directed therapy for patients with metastatic RCC. The objective of this study was to investigate the expression levels of multiple molecular markers in radical nephrectomy specimens from patients with metastatic RCC treated with sunitinib in addition to conventional clinicopathological parameters in order to identify factors predicting the prognosis in these patients. METHODS: This study included 60 consecutive patients undergoing radical nephrectomy, who were diagnosed as having metastatic RCC and subsequently treated with sunitinib. Expression levels of 10
e722
THE JOURNAL OF UROLOGY姞
molecular markers, including Bcl-2, Bcl-xL, Bax, phosphorylated Akt, p44/42 mitogen-activated protein kinase (MAPK) and signal transducers and activation of transcription 3 (STAT3), vascular endothelial growth factor receptor (VEGFR)-1 and -2, and platelet-derived growth factor receptor (PDGFR)-␣ and -, in primary RCC specimens were measured by immunohistochemical staining. RESULTS: Of several factors examined, tumor grade and the expression level of VEGFR-2 were shown to have significant impact on response to sunitinib in these 60 patients. Progression-free survival (PFS) was significantly associated with the expression levels of VEGFR-2 in addition to tumor grade, performance status, MSKCC risk classification system and c-reactive protein level on univariate analysis. Of these significant factors, only VEGFR-2 expression appeared to be independently related to PFS by multivariate analysis. In fact, the PFS in patients with strong expression of VEGFR-2 was significantly favorable compared with that in those with weak expression of VEGFR-2. CONCLUSIONS: It would be useful to consider expression levels of potential molecular markers, particularly VEGFR-2, as well as conventional parameters to select metastatic RCC patients likely to benefit from treatment with sunitinib. Source of Funding: None
1789 PREDICTION OF TKI-THERAPY RESPONSE IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA BY SERUM PROTEOMICS Martina Walter, Jena, Germany; Attila Szendroi, Budapest, Hungary; Nils Kroeger, Christian Bode, Jena, Germany; Thomas Steiner, ERfurt, Germany; Olaf Kniemeyer, Peter Zipfel, Jena, Germany; Imre Romics, Budapest, Hungary; Marc-Oliver Grimm, Kerstin Junker*, Jena, Germany INTRODUCTION AND OBJECTIVES: Several drugs are available for the treatment of metastatic Renal Cell Carcinoma (mRCC). The tyrosine kinase inhibitors (TKIs) Sunitinib and Sorafenib are two therapy options. Both agents lead to primary clinical benefit in the majority of patients while some others show no response and undergo progressive disease. Recognition of these patients would optimize individual treatment and also avoid high costs for health care system. For this reason reliable predictive biomarkers are necessary. The aim of this study is to establish protein signatures predictive for primary therapy response to Sunitinib and Sorafenib. METHODS: We examined serum samples from mRCC-patients before TKI-therapy and after 3 months (26 Sunitinib, 23 Sorafenib). Primary response after 3 months was evaluated by RECIST. Surface-enhanced laser desorption/ionisation time-of-flight mass spectrometry (SELDI-TOF MS) and multiplex two-dimensional fluorescence gel electrophoresis (Multiplex-2DE) were used separating samples into primary clinical benefit (CB) and primary progressive disease (PD). Identification of candidate proteins was performed by peptide mass fingerprinting (PMF). Western Blot and ELISA were carried out for quantification. RESULTS: Protein pattern specific for primary PD could be generated by SELDI-TOF MS and biostatistics. Multiplex-2DE revealed several differentially expressed proteins including serum amyloid A (SAA). Pre-therapeutic SAA-concentrations were significantly different between CB and PD in Sunitinib-treated patients. Comparison of therapeutic SAA-concentrations after 3 months resulted in significant differences for both Sunitinib and Sorafenib. High SAA-levels are representative for primary PD. CONCLUSIONS: Our data show that pre-therapeutic serum is well-suited to establish protein signatures for TKI-therapy response prediction based on the used techniques. Selection of patients for individual therapy seems possible. In this ongoing study further candidates from the detected protein signature have to be identified and validated on an independent patient cohort. Source of Funding: Research grant by Bayer
Vol. 187, No. 4S, Supplement, Tuesday, May 22, 2012
1790 CLINICAL RISK CLASSIFICATION SCORE IN PATIENTS AMENABLE FOR METASTASECTOMY FROM ADVANCED RENAL CELL CARCINOMA Lorenzo Tosco*, Udine, Italy; Hendrik Van Poppel, Leuven, Belgium; Bruno Frea, Udine, Italy; Steven Joniau, Leuven, Belgium INTRODUCTION AND OBJECTIVES: At present, standardized criteria for metastasectomy indication do not exist in patients with advanced renal cell carcinoma (RCC). The present analysis aimed to study clinical prognostic factors in a population of patients treated with nephrectomy or partial nephrectomy at baseline and with at least one surgical resection of metastases. Statistically significant prognostic factors were used to create a novel clinical score. We tested the potential of this score to predict survival rates of patients amenable for metastasectomy. METHODS: 117 consecutive patients were retrospectively studied. All patients underwent prior radical or partial nephrectomy for RCC. Metastasectomies from different anatomical sites were performed, with the main intent to completely resect the lesions even when multiple or synchronous. 14 patients (12%) were lost to follow-up. A multivariable Cox model was used to study the predictive power of different pre-treatment clinical factors. Alpha was set at 0.05. MedCalc® was used for all statistical analyses. RESULTS: Primary T stage ⬎ 3 and Fuhrman grade ⬎ 3 at nephrectomy, DFI (disease free interval) ⬍12 months, the presence of multiple-organ metastases and clinical evidence of non-pulmonary metastases were clinical independent prognostic factors at multivariate analysis Table 1. Those factors were used to obtain a score, ranging from 0 to 5 points. Four different prognostic groups were created: Group A (0-1 point), group B (2 points), group C (3 points) and group D (4-5 points). The results of the Kaplan Meier analysis with Log Rank test, based on these prognostic groups are shown on Fig. 1 (P⬍0,0001). CONCLUSIONS: The present pre-treatment clinical prognostic score has demonstrated to predict survival of patients previously treated with nephrectomy and amenable for metastasectomy. External validation is required to confirm our findings.