MSKCC Motzer Score For Renal Cell Carcinoma

About Motzer score

This is a survival prediction tool based on clinical and laboratory data pertaining to patients diagnosed with metastatic renal cell carcinoma.

The model originates in a 1999 study by Robert J Motzer, MD at the Memorial Sloan Kettering Cancer Center (MSKCC) on a cohort of 670 patients.

There are five parameters which are checked in the score:

■ Performance status (Karnofsky score) <80%;

■ Time from diagnosis to systemic treatment less than 1 year;

■ Hemoglobin* less than the lower limit of normal;

■ Lactate dehydrogenase >1.5x upper limit of normal – where the upper normal is 140 U/L.

■ Corrected calcium >10 mg/dL (2.5 mmol/L).

*The normal range for haemoglobin is referred to as between 13.5 and 17.5 g/dL for men and between 12.0 and 15.5 g/dL for women.

The score retrospectively puts patients in three prognosis groups:

The favourable risk group patients do not present any of the risk factors whilst patients in the intermediate risk group present one or two.

This is so far the most widely recognized prognostic algorithm for RCC, however, since the tool has mostly been used in clinical trials, individual prognosis should remain at the judgment of the clinician.

In 2002 and 2004 new inputs were added to account for patients under treatment with interferon alpha and under cytokine therapy.

Mekhail extension explained

The extended version adds two more items to the five in the Motzer score:

■ Prior radiotherapy;

■ Two or more sites of metastasis.

Metastasis sites are defined as presence of hepatic, lung or retroperitoneal node metastases, according to the Derivation Study.

Whilst the extended version was found to perform similarly to the original one, there is a slight change in the number of survival months (higher than original).

The following table introduces the correlation between the Motzer score (with Mekhail extension) and the risk group, respectively median survival.

The three risk groups were found during the study on clinical trial subjects (353 previously untreated patients) with metastatic renal cell carcinoma (mRCC), between 1987 and 2002.

The compared results between the Motzer score and the Extended Mekhail score on the above cohort of patients were:

The main criticism received by this score refers to the fact that it has not been validated in other studies and that it might not be useful for patients receiving modern therapies such as Sunitinib.

MRCC guidelines

Renal cell carcinoma is a type of renal cancer originated in cells of the proximal renal epithelium. It is the most common kidney cancer and does not present significant symptoms until more advanced stages.

Some of its causes include smoking, obesity, high blood pressure, occupation exposure to chemicals or long term use of non-steroidal anti-inflammatory drugs. Symptoms include blood in urine, flank pain, weight loss, high blood pressure or night sweats.

There are four stages of the carcinoma:

Stage 1 and 2 – when the cancer is still localized in the kidney;

Stage 3 and 4 – when the cancer has spread to a major vein or to lymph nodes.

Stage 4 or metastasis – takes place when cancer has spread beyond lymph nodes, to the lungs, liver, adrenal glands or brain.

The American Cancer Society has reported the following five-year survival rates:

■ Stage 1 RCC – 81%;

■ Stage 2 RCC – 74%;

■ Stage 3 RCC – 53%;

■ Stage 4 RCC – 8%.

Original sources

1. Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol. 1999; 17(8):2530-40.

2. Mekhail TM, Abou-Jawde RM, Boumerhi G, Malhi S, Wood L, Elson P, Bukowski R. Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma. J Clin Oncol. 2005; 23(4):832-41.

Other references

1. Motzer RJ, Bacik J, Murphy BA, Russo P, Mazumdar M. Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol. 2002; 20(1):289-96.

2. Ficarra V, Righetti R, Pilloni S, D'amico A, Maffei N, Novella G, Zanolla L, Malossini G, Mobilio G. Prognostic factors in patients with renal cell carcinoma: retrospective analysis of 675 cases. Eur Urol. 2002; 41(2):190-8.

3. Procopio G, Verzoni E, Iacovelli R, Biasoni D, Testa I, Porcu L, De Braud F. (2012) Prognostic factors for survival in patients with metastatic renal cell carcinoma treated with targeted therapies. British Journal of Cancer. 2012; 107, 1227–1232.