For patients with resectable disease, cure is possible. For patients with unresectable or recurrent and metastatic disease, renal cell cancer becomes a palliative illness. In recent years, with the advent of effective treatments such as sunitinib and sorafenib, people are living longer.

Some of the negative prognostic factors include:

• A poor performance score (AKPS of 70 or less)
• Biochemical abnormalities, including
• A raised LDH > 1.5 times normal
• A raised corrected calcium (> 2.5)
• A low haemoglobin (below the lower limit of normal)
• No previous nephrectomy (that is, locally advanced disease that could not be resected as opposed to recurrent disease post surgery)

Certain histological sub-types of renal cell cancer are associated with a poor prognosis too. Patients with sarcomatoid features generally have a poorer prognosis. In one study, approximately 20% of patients with this cancer had a partial response to treatment, 50% had a stable disease and 30% had progressive disease, with a overall median survival of 5 months.¹⁾