Naito Sei, Narisawa Takafumi, Kato Tomoyuki, Ichiyanagi Osamu, Kurokawa Masayuki, Yagi Mayu, Kanno Hidenori, Kurota Yuta, Yamagishi Atsushi, Sakurai Toshihiko, Nishida Hayato, Yamanobe Takuya, Tsuchiya Norihiko
Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan.
Int J Urol. 2021 Apr;28(4):450-456. doi: 10.1111/iju.14490. Epub 2021 Feb 1.
The utility of brain metastasis screening in asymptomatic metastatic renal cell carcinoma is controversial. Our study evaluated the utility of routine head computed tomography during systemic therapy.
We retrospectively investigated 152 metastatic renal cell carcinoma patients who did not initially have brain metastasis at Yamagata University Hospital from January 2008 to July 2019. Patients who routinely received head computed tomography scan together with routine contrast-enhanced chest/abdominal/pelvic computed tomography scan every 2-4 months during systemic therapy ("Routine head computed tomography" group, n = 95) and patients without routine head computed tomography ("No routine head computed tomography" group, n = 57) were compared.
Brain metastasis occurred in 16 patients in the "Routine head computed tomography" group and six patients in the "No routine head computed tomography" group. There was no statistical difference in overall survival after metastatic renal cell carcinoma diagnosis between groups (53.4 vs 37.3 months, respectively, P = 0.357) and neurological symptom-free survival after metastatic renal cell carcinoma diagnosis (53.4 vs 36.6 months, P = 0.336). Although there was no statistical difference on incidence of unrecovered neurological symptom (25.0% vs 50.0%, P = 0.334), fewer patients in the "Routine head computed tomography" group required craniotomy (0% vs 66.7%, P = 0.002). In the "No routine head computed tomography" group, the neurological symptom resolved for all patients without craniotomy.
Routine head computed tomography during systemic therapy for metastatic renal cell carcinoma is not significantly associated with improved brain metastasis prognosis. However, routine head computed tomography enables brain metastasis diagnosis in the asymptomatic phase, which can avoid craniotomy.
无症状转移性肾细胞癌患者进行脑转移筛查的效用存在争议。我们的研究评估了全身治疗期间常规头部计算机断层扫描的效用。
我们回顾性调查了2008年1月至2019年7月在山形大学医院最初没有脑转移的152例转移性肾细胞癌患者。比较全身治疗期间每2 - 4个月常规接受头部计算机断层扫描以及常规对比增强胸部/腹部/盆腔计算机断层扫描的患者（“常规头部计算机断层扫描”组，n = 95）和未进行常规头部计算机断层扫描的患者（“无常规头部计算机断层扫描”组，n = 57）。
“常规头部计算机断层扫描”组有16例患者发生脑转移，“无常规头部计算机断层扫描”组有6例患者发生脑转移。两组转移性肾细胞癌诊断后的总生存期（分别为53.4个月和37.3个月，P = 0.357）以及转移性肾细胞癌诊断后的无神经症状生存期（53.4个月和36.6个月，P = 0.336）无统计学差异。虽然未恢复神经症状的发生率无统计学差异（25.0%对50.0%，P = 0.334），但“常规头部计算机断层扫描”组需要开颅手术的患者较少（0%对66.7%，P = 0.002）。在“无常规头部计算机断层扫描”组中，所有未进行开颅手术的患者神经症状均得到缓解。
转移性肾细胞癌全身治疗期间常规头部计算机断层扫描与改善脑转移预后无显著关联。然而，常规头部计算机断层扫描能够在无症状期诊断脑转移，从而避免开颅手术。
