Department of Urology, SUNY Upstate Medical University, Syracuse, NY.
Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH.
Urol Oncol. 2019 Mar;37(3):182.e9-182.e15. doi: 10.1016/j.urolonc.2018.10.021. Epub 2018 Dec 5.
Renal cell carcinoma (RCC) brain metastasis is generally viewed as poor prognostic features and often excludes patients from cytoreductive nephrectomy or participation in clinical trials. We aim to evaluate patients presenting with brain metastasis and their outcomes.
Surveillance Epidemiology and End Results-18 registries database was queried for all patients with metastatic RCC from 2010 to 2014. Patients with renal cancer as their only malignancy were included. Information was available for metastatic disease to bone, liver, lung, and brain. Patients were then further stratified into those with isolated brain metastases and those with additional metastasis to other sites as well. Overall survival was compared between groups using logrank analysis.
A total of 6,667 patients were identified with metastatic RCC. Among them, 775 (12.1%) had brain metastasis at time of diagnosis. Of these patients with brain metastasis, 152 (20.4%) had isolated brain metastasis. Only 23.8% of all patients with brain metastasis underwent cytoreductive nephrectomy, compared to 40.8% of patients with isolated brain metastasis. Patients with brain and other metastasis and brain metastasis only treated by cytoreductive nephrectomy exhibited a median survival of 11 and 33 months, respectively. Those patients who did not undergo cytoreductive nephrectomy experienced a median survival of 4 and 5 months, respectively.
It appears that selected patients with brain metastasis may experience durable long-term survival. This information may be beneficial for patient counseling, surgical planning, and consideration for inclusion in clinical trials.
肾细胞癌（RCC）脑转移通常被视为预后不良的特征，往往使患者无法接受肾细胞切除术或参与临床试验。我们旨在评估出现脑转移的患者及其预后。
检索 2010 年至 2014 年期间来自监测、流行病学和最终结果-18 注册数据库的所有转移性 RCC 患者。纳入仅患有肾细胞癌的患者。有骨、肝、肺和脑转移的信息。然后，将患者进一步分为孤立性脑转移和其他部位的转移患者。使用对数秩分析比较组间的总生存率。
共确定了 6667 例转移性 RCC 患者。其中，775 例（12.1%）在诊断时发生脑转移。在这些脑转移患者中，152 例（20.4%）为孤立性脑转移。仅有 23.8%的所有脑转移患者接受了肾细胞切除术，而孤立性脑转移患者的这一比例为 40.8%。接受肾细胞切除术治疗的脑和其他转移及单纯脑转移患者的中位生存期分别为 11 个月和 33 个月。未接受肾细胞切除术的患者中位生存期分别为 4 个月和 5 个月。
似乎有选择的脑转移患者可能会经历持久的长期生存。这些信息可能有助于患者咨询、手术计划，并考虑纳入临床试验。
