Mekhail Extension of the Motzer Score

Karnofsky Performance Status <80%

Hemoglobin Below Lower Limit of Normal

Corrected Calcium >10 mg/dL

LDH >1.5× Upper Limit of Normal

No Prior Nephrectomy

Prior Radiation Therapy

Hepatic Metastases

Retroperitoneal Lymph Node Metastases

Bone Metastases

Multiple Organ Site Metastases (≥2 sites)

Extended Motzer Score: –

Awaiting input

Select all criteria to compute the score.

Predicts metastatic renal cell carcinoma survival, more accurately than the Motzer Score.

Why Use

There are no validated scoring systems for predicting survival in mRCC. Using a score may help suggest categories of survival time better than clinical judgment alone.

When to Use

Patients with mRCC being considered for clinical trial enrollment.

Formula

Addition of selected points: 0 points 1 point LDH >1.5× upper limit of normal Normal: 140 U/L No Yes Hgb 10 mg/dL (3 mmol/L) No Yes Time from initial diagnosis to systemic treatment <1 year No Yes Prior treatment with radiation No Yes ≥2 sites of metastasis No Yes

Pearls / Pitfalls

This score placed clinical trial subjects from the 1970s-1990s with metastatic renal cell carcinoma (mRCC) into three groups with “poor,” “intermediate,” and “favorable” survival. There are no successful validations (later studies found different predictors), and the score may not apply to patients in common practice or those receiving modern targeted therapies such as sunitinib.

Management

We are unaware of validated management algorithms using the score.

Critical Actions

The Motzer score (with or without the Mekhail extension) is not known to be accurate for individual survival prediction and should be considered a general guide rather than a concrete predictor.

Advice

The Motzer score (which performs similarly with or without the Mekhail extension) is among the most commonly used for mRCC, and is probably best used for selecting patients to enroll in clinical trials. The score retrospectively identified variables associated with survival, which may ultimately help predict outcomes.

More Information

Criteria are the same as the Motzer Score , with Karnofsky performance status excluded and with two additions: Prior treatment with radiation. ≥2 sites of metastasis. Risk groups and correlated median survival also differ from the Motzer Score: Score Risk Median Survival 0-1 Favorable 28 months 2 Intermediate 14 months ≥3 Poor 5 months