Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Clin Genitourin Cancer. 2017 Dec;15(6):717-723. doi: 10.1016/j.clgc.2017.05.010. Epub 2017 May 10.
We evaluated the oncological outcomes of synchronous or metachronous brain metastasis (BM) of metastatic renal cell carcinoma (RCC) according to clinicopathologic factors.
Patients with metastatic RCC (n = 93) with synchronous and metachronous BM were retrospectively identified. We analyzed patients and tumor characteristics, treatment methods, prognostic factors, BM progression, and overall survival (OS).
Seventy-six patients (81.7%) received local therapy (stereotactic radiosurgery [60.2%], radiation therapy [22.6%], and neurosurgery [10.8%]), and 54 patients (58.1%) were treated with systemic medical therapy. In multivariable analysis, poor Memorial Sloan-Kettering Cancer Center (MSKCC) risk (hazard ratio [HR] 3.672; 95% confidence interval [CI], 1.441-9.36; P = .0064), sarcomatoid component (HR 4.264; 95% CI, 2.062-8.820; P = .0001), and multiple BMs (HR 2.838; 95% CI, 1.690-4.767; P = .0001) were prognostic indicators of a poorer OS outcome. Local (HR 0.436; 95% CI, 0.237-0.802; P = .0076) and systemic treatment (HR 0.322; 95% CI, 0.190-0.548; P < .0001) were independent factors for a better OS. Although OS from initial RCC diagnosis in patients with metachronous BM was better than that for patients with synchronous BM, there were no differences found between synchronous and metachronous patients in terms of BM progression and OS after the diagnosis of BM.
Poor MSKCC risk, sarcomatoid component of histology, and multiple BMs are prognostic indicators for poor OS in patients with BM from metastatic RCC. Systemic and/or local treatment improves the OS. Because the type of BM, synchronous or metachronous, does not influence BM progression or the OS outcome, routine evaluation for BM is not recommended.
我们根据临床病理因素评估转移性肾细胞癌（RCC）的同步或异时性脑转移（BM）的肿瘤学结局。
回顾性地确定了 93 例转移性 RCC 患者（n=93）的同步和异时性 BM。我们分析了患者和肿瘤特征、治疗方法、预后因素、BM 进展和总生存期（OS）。
76 例（81.7%）患者接受了局部治疗（立体定向放射外科治疗[60.2%]、放射治疗[22.6%]和神经外科手术[10.8%]），54 例（58.1%）患者接受了全身药物治疗。多变量分析显示，较差的纪念斯隆-凯特琳癌症中心（MSKCC）风险（危险比[HR]3.672；95%置信区间[CI]1.441-9.36；P=0.0064）、肉瘤样成分（HR 4.264；95%CI，2.062-8.820；P=0.0001）和多个 BM（HR 2.838；95%CI，1.690-4.767；P=0.0001）是 OS 不良结局的预后指标。局部治疗（HR 0.436；95%CI，0.237-0.802；P=0.0076）和全身治疗（HR 0.322；95%CI，0.190-0.548；P<0.0001）是 OS 改善的独立因素。虽然异时性 BM 患者的初始 RCC 诊断后的 OS 优于同步性 BM 患者，但在 BM 诊断后的 BM 进展和 OS 方面，同步性和异时性患者之间没有差异。
较差的 MSKCC 风险、肉瘤样组织学成分和多个 BM 是转移性 RCC 患者 BM 中预后不良的指标。全身和/或局部治疗可改善 OS。由于 BM 的类型（同步或异时性）不影响 BM 进展或 OS 结局，因此不建议常规评估 BM。
