Department of Oncology, Tom Baker Cancer Centre, 1331 29th Street NW, Calgary, Alberta, Canada.
Clin Genitourin Cancer. 2013 Sep;11(3):311-5. doi: 10.1016/j.clgc.2013.04.012. Epub 2013 May 15.
The outcomes and prognosis of patients with brain metastases from advanced renal cell carcinoma (RCC) are not well characterized in the targeted-therapy era.
Data from patients with metastatic RCC (mRCC) and brain metastases treated with targeted therapy were collected through the International Metastatic Renal Cell Carcinoma Database Consortium from 7 cancer centers.
Overall, 106 (15%) of 705 patients with mRCC had brain metastases. Forty-seven patients had brain metastases at the start of first-line anti-vascular endothelial growth factor therapy, and the rest developed metastases during follow-up. Of the patients with brain metastases, 12%, 42% and 29% were in the favorable, intermediate, and poor prognosis groups, respectively, per the Heng criteria. Ninety percent had cerebral metastases, 17% had cerebellar metastases, 37% had a Karnofsky performance status (KPS) <80%, and 80% had neurologic symptoms at presentation. The median largest size and number of brain metastases was 1.8 cm (range, 0.2-6.6 cm) and one (range, 1 to innumerable), respectively. The patients were treated with sunitinib (n = 77), sorafenib (n = 23), bevacizumab (n = 5), and temsirolimus (n = 1). Local disease treatment included whole brain radiotherapy (81%), stereotactic radiosurgery (25%), and neurosurgery (25%). On multivariable analysis, KPS < 80%, diagnosis to treatment with targeted therapy <1 year, and a higher number of brain metastases (>4) was associated with worse survival from the time of diagnosis with brain metastases.
Patients with brain metastases from RCC are unlikely to be in the favorable risk group. KPS at the start of therapy, diagnosis to treatment time, and the number of brain metastases are prognostic factors for overall survival.
在靶向治疗时代，晚期肾细胞癌（RCC）脑转移患者的预后和结局尚不清楚。
通过国际转移性肾细胞癌数据库联盟，从 7 家癌症中心收集接受靶向治疗的转移性 RCC（mRCC）和脑转移患者的数据。
总体而言，705 例 mRCC 患者中有 106 例（15%）发生脑转移。47 例患者在一线抗血管内皮生长因子治疗开始时即发生脑转移，其余患者在随访期间发生转移。根据 Heng 标准，脑转移患者中，分别有 12%、42%和 29%为预后良好、预后中等和预后不良组。90%的患者有脑转移，17%的患者有小脑转移，37%的患者 Karnofsky 表现状态（KPS）<80%，80%的患者在就诊时存在神经症状。最大脑转移灶的中位大小和数量分别为 1.8cm（范围 0.2-6.6cm）和 1 个（范围 1 个至无数个）。患者接受舒尼替尼（n=77）、索拉非尼（n=23）、贝伐珠单抗（n=5）和替西罗莫司（n=1）治疗。局部疾病治疗包括全脑放疗（81%）、立体定向放疗（25%）和神经外科手术（25%）。多变量分析显示，KPS<80%、诊断至靶向治疗时间<1 年和脑转移灶数量较多（>4 个）与脑转移诊断后生存时间更差相关。
RCC 脑转移患者不太可能处于低危风险组。治疗开始时的 KPS、诊断至治疗时间和脑转移灶数量是总生存期的预后因素。
