Feasibility of the ACL (albumin, C-reactive protein and lactate dehydrogenase) model as a novel prognostic tool in patients with metastatic renal cell carcinoma previously receiving first-line targeted therapy

Purpose: To develop a novel model to predict outcomes in patients with previously treated metastatic renal cell carcinoma. Patients and methods: This study included 78 consecutive metastatic renal cell carcinoma patients receiving first- and second-line targeted therapies at our institution. Predictive factors of overall survival (OS) at the second-line setting in these patients were investigated, and a novel prognostic model was developed. Results: Median OS from the initiation of second-line therapy was 21.9 months. A multivariate analysis of several parameters identified the following independent predictors associated with poor OS: albumin (Alb, <= 3.5 g/dl), C-reactive protein (CRP, >0.5 mg/dl), and lactate dehydrogenase (LDH, >1.5 x upper limit of normal). When patients were divided into 3 groups based on the positive numbers of these 3 independent risk factors, named the ACL (Alb, CRP, and LDH) model, median OS durations were 50 months in the favorable risk group without risk factors (n = 26), 25 months in the intermediate-risk group with a single risk factor (n = 24), and 8 months in the poor risk group (n = 28) with multiple risk factors. The superiority of the ACL model as a prognostic tool to the Memorial Sloan Kettering Cancer Center model for previously treated patients and the International Metastatic Renal Cell Carcinoma Database Consortium model was demonstrated by Harrell's concordance index and a decision curve analysis. Conclusions: The ACL model in the second-line targeted therapy setting may predict outcomes more accurately than the Memorial Sloan Kettering Cancer Center and International Metastatic Renal Cell Carcinoma Database Consortium models. (C) 2019 Elsevier Inc. All rights reserved.