Prostate Center and Division of Urology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan.
Division of Surgical Pathology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan.
Int J Clin Oncol. 2019 Oct;24(10):1231-1237. doi: 10.1007/s10147-019-01474-2. Epub 2019 May 28.
Patients with brain metastasis from renal cell carcinoma have poor outcomes despite recent advances in diagnosis and treatment. Moreover, factors affecting such poor outcomes are unclear. This study aimed to evaluate the prognostic factors associated with overall survival in renal cell carcinoma patients with brain metastasis.
We retrospectively reviewed the data of 50 consecutive patients with brain metastasis from renal cell carcinoma at our institution between 1988 and 2017. The evaluated prognostic factors for overall survival included clinicopathological factors at diagnosis, treatment for brain metastasis, and the Graded Prognostic Assessment score of renal cell carcinoma. The associations between preoperative clinicopathological factors and overall survival were assessed using the log-rank test and Cox proportional hazards models for univariate and multivariate analyses, respectively.
Forty-five patients were included, among whom 39 died during follow-up. The median follow-up was 8.2 months. The median survival time was 8.2 months (95% confidence interval 5.5-13.7). A Graded Prognostic Assessment score ≤ 2 (hazard ratio 1.967; 95% confidence interval 1.024-3.892; P = 0.042), the presence of sarcomatoid components (hazard ratio 3.299; 95% confidence interval 1.424-7.193; P = 0.007), and no treatment for brain metastasis (hazard ratio 2.594; 95% confidence interval 1.033-5.858; P = 0.043) were independently associated with poor prognosis in the multivariate analysis.
Patients with renal cell carcinoma who develop brain metastasis have poor overall survival. The Graded Prognostic Assessment score, sarcomatoid components, and treatment for brain metastasis from renal cell carcinoma were independent factors associated with prognosis.
尽管近年来在诊断和治疗方面取得了进展，但肾细胞癌脑转移患者的预后仍较差。此外，影响这些不良预后的因素尚不清楚。本研究旨在评估与肾细胞癌脑转移患者总生存相关的预后因素。
我们回顾性分析了 1988 年至 2017 年期间我院 50 例肾细胞癌脑转移患者的资料。评估总生存的预后因素包括诊断时的临床病理因素、脑转移的治疗以及肾细胞癌的分级预后评估评分。使用对数秩检验和 Cox 比例风险模型分别对术前临床病理因素与总生存的相关性进行单因素和多因素分析。
45 例患者纳入研究，随访期间 39 例患者死亡。中位随访时间为 8.2 个月。中位生存时间为 8.2 个月（95%置信区间 5.5-13.7）。分级预后评估评分≤2（风险比 1.967；95%置信区间 1.024-3.892；P=0.042）、存在肉瘤样成分（风险比 3.299；95%置信区间 1.424-7.193；P=0.007）和未治疗脑转移（风险比 2.594；95%置信区间 1.033-5.858；P=0.043）在多因素分析中与预后不良独立相关。
患有肾细胞癌脑转移的患者总体生存较差。分级预后评估评分、肉瘤样成分和肾细胞癌脑转移的治疗是与预后相关的独立因素。
