The use of prognostic factors in metastatic renal cell carcinoma

• The current available prognostic factors as well as prognostic models in metastatic renal cell carcinoma.
• How these models help clinicians in their decision making as well as patient counseling.
• How prognostic models can be used in clinical trial design for better risk stratification.
• The use of new biomarkers in clinical settings.

BackgroundOver the last decade, the treatment landscape of metastatic renal cell carcinoma (mRCC) has evolved tremendously. The outcome of patients with mRCC has been improved since the advent of targeted therapy.ObjectiveIn this review, we address the use of prognostic schema in the era of targeted treatment. This article summarizes the current available prognostic models and the evidence to support their use in clinical settings.ConclusionPrognostic models can help guide clinicians in their decision making, as they have been validated in the first- and second-line targeted therapy settings as well as in non–clear cell mRCC. Prognostic factors are important in patient counseling, clinical trial stratification, and therapy planning. Very selected favorable-risk patients with minimal bulk and slow-growing disease could potentially be observed before needing treatment. Patients with poor-risk disease may be eligible for treatment with temsirolimus. Patients with a very poor prognosis may not be suitable candidates for cytoreductive nephrectomy. New biomarkers are on the horizon, though their roles need to be validated and their additive contribution to improve existing prognostic models examined.