The Heng criteria were described in 20091 to provide a contemporary prognostic model for metastatic renal cell carcinoma (mRCC) patients treated with anti-VEGF therapy. Six independent negative prognostic factors were identified - Karnovsky performance status <80, time to treatment >1 year, haemoglobin level less than lower limit of normal, platelet count greater than upper limit of normal (>ULN), neutrophils >ULN and calcium >ULN. Patients were stratified into favourable, intermediate and poor risk groups based on their score. We examined the validity of the Heng criteria for a cohort of 67 patients with clear cell mRCC and then applied it irrespective of treatment regimen.
Characteristics and outcomes of 67 patients who met the inclusion criteria with clear cell mRCC were collected. Patients were divided into prognostic groups per the Heng criteria with adjustments made for the time to treatment criterion to allow stratification of untreated patients. The overall survival (OS) for the prognostic groups were analysed with the Kaplan-Meier method.
The median age at metastatic diagnosis was 63.8 years (range 41.2 to 87.6). Forty-six of the 67 patients were male (68.7%). Forty-seven (70.1%) were treated with a first-line TKI, of which 41 (89.4%) were treated with sunitinib. The median OS for the entire cohort was 20.5 months (95% CI 11.4 to 29.6). The median OS in TKI-treated patients was 30.3 months for the favourable risk group, and 24.5 (95% CI 13.9 – 35.2) and 9.0 (95% CI 5.0 – 13.0) months for the intermediate and poor risk groups respectively. When all patients were included, the median OS was not reached for the favourable risk group and was 24.5 (95% CI 13.3 – 35.8) and 7.0 (95% CI 0.0 – 14.6) months for the intermediate and poor risk groups respectively.
The prognosis of our cohort of patients could be predicted with the Heng criteria. In addition, our analysis demonstrated that the Heng criteria can be applied to a more generalised cohort and is not dependent on treatment status.