Hypercoagulability as a prognostic factor for survival in patients with metastatic renal cell carcinoma

BACKGROUND: In experimental systems, interference with coagulation can affect tumor biology. We suggested that abnormal coagulation could be a negative predictor for response to immunotherapy and survival among patients with metastatic renal cell carcinoma (MRCC). METHODS: To address this issue, retrospective analysis of 289 previously untreated MRCC patients entering on institutional review board-approved clinical trials was conducted between 2003 and 2006. In addition, two groups of MRCC patients with (n = 28) or without (n = 28) hypercoagulability were compared in a case-control study. Baseline and treatment characteristics were well balanced. RESULTS: Hypercoagulability was present at treatment start in 40% of patients. Median baseline fibrinogen was 6.2 mg/dl. Serious disorders were found in 68% of patients. Abnormal coagulation was strongly associated with a number of metastatic sites (2 and more metastatic sites vs. 0–1 (P = .001). Patients with high extent of hypercoagulability had significantly higher number of metastatic sites (P = .02). On univariate analysis, patients with hypercoagulability had significantly shorter overall survival than patients with normal coagulation; median survivals of 8.9 and 16.3, respectively (P = .001). Short survival and low response rate also were significantly associated with hypercoagulability in a case-control study. Median survival was 8.2 months and 14.6 months, respectively (P = .0011). Disease control rate (overall response + stable disease) was significantly higher in patients with normal coagulation: 71.4 versus 42.9% (P = .003). CONCLUSION: Hypercoagulability disorders were found to be prognostic factor for response rate to systemic therapy and survival in patients with MRCC.