Prognostic value of performance status in metastatic renal cell carcinoma patients receiving tyrosine kinase inhibitors: a systematic review and meta-analysis

BACKGROUND: The association between performance status (PS) and the prognosis of metastatic renal cell carcinoma (mRCC) patients receiving tyrosine kinase inhibitors (TKIs) remains controversial. The aim of this study is to evaluate the prognostic value of PS in mRCC patients treated with TKIs. METHODS: Electronic databases were searched to identify the studies that had assessed the association between pretreatment PS and prognosis in mRCC patients receiving TKIs. Hazard ratios (HRs) and 95% confidence interval (CI) for overall survival (OS) and progression-free survival (PFS) from eligible studies were used to calculate combined HRs. The heterogeneity across the included studies was assessed by Cochrane’s Q test and I(2) statistic. The Begg’s funnel plot and Egger’s linear regression teats were used to evaluate the potential publication bias. The meta-analysis was performed with RevMan 5.3 and Stata SE12.0 according to the PRISMA guidelines. RESULTS: A total of 6780 patients from 19 studies were included in this meta-analysis. The results showed that a poor PS was an effective prognostic factor of both OS (pooled HR: 2.08, 95% CI: 1.78–2.45) and PFS (pooled HR: 1.51, 95% CI: 1.20–1.91). Subgroup analysis revealed that poor PS significantly associated with poor OS and PFS in studies using Karnofsky PS scale (OS, pooled HR: 2.20, 95% CI: 1.65–2.94; PFS, pooled HR: 1.74, 95% CI: 1.19–2.56), conducted in Asia (OS, pooled HR: 2.25, 95% CI: 1.71–2.95; PFS, pooled HR: 1.73, 95% CI: 1.14–2.64) and Newcastle-Ottawa Scale score of 8 (OS, pooled HR: 2.61, 95% CI: 1.92–3.55; PFS, pooled HR: 2.43, 95% CI: 1.36–4.33). CONCLUSIONS: This study suggests that a poor PS is significantly associated with poor prognosis in mRCC patients receiving TKIs.