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    Patent Pending

    Mekhail Extension of the Motzer Score

    Predicts metastatic renal cell carcinoma survival, more accurately than the Motzer Score.
    Favorite
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with mRCC being considered for clinical trial enrollment.

    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.

    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.

    Result:

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    Next Steps
    Evidence
    Creator Insights

    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.

    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.

    Formula

    Addition of selected points:

     

    0 points

    1 point

    LDH >1.5× upper limit of normal

    Normal: 140 U/L

    No

    Yes

    Hgb <lower limit of normal

    Normal: <12 g/dL (120 g/L)

    No

    Yes

    Corrected serum calcium >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



    Facts & Figures

    Criteria are the same as the Motzer Score, with Karnofsky performance status excluded and with two additions:

    1. Prior treatment with radiation.
    2. ≥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

    Literature

    Dr. Tarek Mekhail

    About the Creator

    Tarek M. Mekhail, MD, MSc, is an associate professor of medicine at the University of Central Florida and the medical director of the Thoracic Oncology Program at the Florida Hospital Cancer Institute. Dr. Mekhail has been voted one of the Best Doctors in America in 2007-2008, 2008-2009 and 2009-2010. His research focuses on novel therapies and risk stratification in lung, kidney, and head/neck cancers.

    To view Dr. Tarek Mekhail's publications, visit PubMed