Centre Léon Bérard, 28 Prom. Lea et Napoleon Bullukian, 69008, Lyon, France.
Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France.
J Neurooncol. 2021 May;153(1):133-141. doi: 10.1007/s11060-021-03751-5. Epub 2021 Apr 10.
Brain metastases (BM) usually represent a poor prognostic factor in solid tumors. About 10% of patients with renal cancer (RCC) will present BM. Local therapies such as stereotactic radiotherapy (SRT), whole brain radiotherapy (WBRT), and surgery are used to achieve brain control. We compared survival between patients with synchronous BM (SynBM group) and metachronous BM (MetaBM group).
It is a retrospective study of patients with clear cell renal cell carcinoma (ccRCC) and BM treated with TKI between 2005 and 2019 at the Centre Léon Bérard in Lyon. We collected prognostic factors: The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk score, the TNM stage, the histological subtypes and the Fuhrman grade. Overall survival (OS) was defined from diagnosis of metastatic ccRCC to death. Brain progression-free survival (B-PFS) was defined from focal brain therapy to brain progression or death.
99 patients were analyzed, 44 in the SynBM group and 55 in the MetaBM group. OS in the MetaBM group was 49.4 months versus 19.6 months in the SynBM group, p = 0.0002. The median time from diagnosis of metastasic disease to apparition of BM in the MetaBM group was 22.9 months (4.3; 125.7). SRT was used for 101 lesions (66.4%), WBRT for 25 patients (16.4%), surgery for 21 lesions (13.8%), surgery followed by radiation for 5 lesions (3.3%). B-PFS for all patients was 7 months (IC95% [5.0-10.5]).
Survival of patients with synchronous BM is inferior to that of patients with metachronous BM. Outcome is poor in both cases after diagnosis of BM. Brain screening should be encouraged at time of diagnosis of metastatis in ccRCC.
脑转移（BM）通常是实体瘤预后不良的因素。约 10%的肾癌（RCC）患者会出现 BM。立体定向放疗（SRT）、全脑放疗（WBRT）和手术等局部治疗方法用于控制脑部疾病。我们比较了同步脑转移（SynBM 组）和异时性脑转移（MetaBM 组）患者的生存情况。
这是一项回顾性研究，纳入了 2005 年至 2019 年在里昂莱昂·贝拉德中心接受 TKI 治疗的 clear cell renal cell carcinoma（ccRCC）和 BM 患者。我们收集了预后因素：国际转移性肾细胞癌数据库联盟（IMDC）风险评分、TNM 分期、组织学亚型和 Fuhrman 分级。总生存期（OS）定义为转移性 ccRCC 诊断至死亡。脑无进展生存期（B-PFS）定义为从局部脑治疗到脑进展或死亡。
共分析了 99 例患者，其中 44 例为 SynBM 组，55 例为 MetaBM 组。MetaBM 组的 OS 为 49.4 个月，SynBM 组为 19.6 个月，p=0.0002。MetaBM 组从转移性疾病诊断到 BM 出现的中位时间为 22.9 个月（4.3；125.7）。101 个病灶接受 SRT（66.4%），25 个患者接受 WBRT（16.4%），21 个病灶接受手术（13.8%），5 个病灶接受手术联合放疗（3.3%）。所有患者的 B-PFS 为 7 个月（IC95% [5.0-10.5]）。
同步 BM 患者的生存情况劣于异时性 BM 患者。两种情况下 BM 确诊后的预后均较差。在 ccRCC 出现转移时，应鼓励进行脑部筛查。
