This MSKCC Motzer score for renal cell carcinoma calculator predicts survival for patients with metastatic kidney cancer. There is in depth information on the original study and the Mekhail extension below the form.
How does this MSKCC Motzer score for renal cell carcinoma calculator work?
This health tool determines survival in the case of patient with metastatic renal cell carcinoma, based on their clinical and laboratory data. It is based on the 670 patient, original, 1999 study by Robert J Motzer, MD at the Memorial Sloan Kettering Cancer Center (MSKCC) and is the most widely recognized prognostic algorithm for RCC.
The MKCC/Motzer score or the MSKCC RCC risk score as it is also called, retrospective places clinical trial subjects in three prognostic groups: poor, intermediate and favorable.
Two of the limitations of the study consist of the lack of subsequent successful validations and the fact that the score has not been applied successfully to patients receiving modern therapies (i.e. sunitinib).
However, in 2002 and 2004 new inputs were added to account for patients that are treated with interferon alpha and patients under cytokine therapy.
There are two tabs in the MSKCC Motzer score for renal cell carcinoma calculator. The first tab consists of the Motzer score while the second adds the Mekhail extension to the original score.
Each tab performs a different calculation and each result is based on the interpretation method in the respective study.
Motzer score and its interpretation
The following five parameters are taken into account and each adds 1 point to the final result when found to be positive:
■ Performance status (Karnofsky score) < 80%.
■ Time from diagnosis to systemic treatment.
■ Hemoglobin less than the lower limit of normal – where the normal ranges for hemoglobin are between 13.5 and 17.5 g/dL for men and between 12.0 and 15.5 g/dL for women.
■ 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)
When one of the above parameters is present, it is considered to be a poor prognostic factor.
The favorable risk group is defined as having no poor prognostic risk factors while the intermediate risk group has one or two poor prognostic factors.
The table below presents the risk group interpretation and the median survival for each of the possible Motzer scores which range from 0 to 5.
| Motzer Score | Risk Group | Median Survival |
| 0 | Favorable | 20 months |
| 1 - 2 | Intermediate | 10 months |
| ≥ 3 | Poor | 4 months |
Given that this is a tool mostly used in clinical trials and has not been validated for MSKCC prognostic use in individual patients, the later remains at the judgment of the clinician and the Motzer score should be used as a guide.
Mekhail extension to Motzer score
The extension to the original prognostic factors has brought two more items: the existence of prior radiotherapy and the number of metastasis sites. Below are all seven presented:
■ Performance status (Karnofsky score) < 80%.
■ Time from diagnosis to systemic treatment.
■ Hemoglobin less than the lower limit of normal.
■ Lactate dehydrogenase > 1.5x upper limit of normal.
■ Corrected calcium > 10 mg/dL (2.5 mmol/L).
■ Prior radiotherapy.
■ Two or more sites of metastasis – which are represented by the presence of helpatic, lung and/or retroperitoneal node metastases, according to the Derivation Study.
The original score is said to perform similarly, with or without the Mekhail extension for MSKCC kidney cancer risk stratification. There are, however, changes in the number of survival months, slightly higher in the extended version.
The table below presents the risk group and median survival interpretation.
| Motzer Score With Mekhail Extension | Risk Group | Median Survival |
| 0 | Favorable | 26 months |
| 1 - 2 | Intermediate | 14 months |
| ≥ 3 | Poor | 7.3 months |
References
1) Tsui KH, Shvarts O, Smith RB, Figlin RA, deKernion JB, Belldegrun A. (2000) Prognostic indicators for renal cell carcinoma: a multivariate analysis of 643 patients using the revised 1997 TNM staging criteria. J Urol; 163(4):1090-5; quiz 1295.
2) Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J. (1999) Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol; 17(8):2530-40.
3) Plimack ER, Hudes GR. (2011) Selecting Targeted Therapies for Patients With Renal Cell Carcinoma: Metastatic Clear Cell RCC: First-Line Treatment. J Natl Compr Canc Netw; 9(9):997-1007.
4) Mekhail TM, Abou-Jawde RM, Boumerhi G, Malhi S, Wood L, Elson P, Bukowski R. (2005) 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; 23(4):832-41.
5) 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 107, 1227–1232.
6) Escudier B, Eisent, Porta C, Patard J, Khoo V, Algaba F, Mulders P, Kataja V. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Oxford Journals: Annals of Oncology; 23(7) Pp. vii65-vii71.
7) Santoni M, De Tursi M, Felici A, Re GL, Ricotta R, Ruggeri EM, Sabbatini R, Santini D, Vaccaro V, Milella M. (2013) Management of Metastatic Renal Cell Carcinoma Patients With Poor-Risk Features Current Status and Future Perspectives. Expert Rev Anticancer Ther;13(6):697-709.
8) Ficarra V, Righetti R, Pilloni S, D'amico A, Maffei N, Novella G, Zanolla L, Malossini G, Mobilio G. (2002) Prognostic factors in patients with renal cell carcinoma: retrospective analysis of 675 cases. Eur Urol; 41(2):190-8.
27 Aug, 2016