Medical Oncology Unit, Azienda Ospedaliera Universitaria Policlinico di Bari, Bari, Italy.
Medical Oncology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy.
ESMO Open. 2023 Aug;8(4):101598. doi: 10.1016/j.esmoop.2023.101598. Epub 2023 Jul 17.
The treatment of patients with brain-spread renal cell carcinoma (RCC) is an unmet clinical need, although more recent therapeutic strategies have significantly improved RCC patients' life expectancy. Our multicenter, retrospective, observational study investigated a real-world cohort of patients with brain metastases (BM) from RCC (BMRCC).
A total of 226 patients with histological diagnosis of RCC and radiological evidence of BM from 22 Italian institutions were enrolled. Univariate and multivariate models were performed to investigate the impact of clinicopathological features and multimodal treatments on both overall survival (OS) from the BM diagnosis and intracranial progression-free survival (iPFS).
The median OS from the BM diagnosis was 18.8 months (interquartile range: 6.2-43 months). Multivariate analysis confirmed the following as positive independent prognostic factors: a Karnofsky Performance Status >70% [hazard ratio (HR) = 0.49, 95% confidence interval (CI) 0.26-0.92, P = 0.0026] and a single BM (HR = 0.51, 95% CI 0.31-0.86, P = 0. 0310); in contrast, the following were confirmed as worse prognosis factors: progressive extracranial disease (HR = 1.66, 95% CI 1.003-2.74, P = 0.00181) and only one line of systemic therapy after the BM occurrence (HR = 2.98, 95% CI 1.62-5.49, P = 0.029). Subgroup analyses showed no difference in iPFS according to the type of the first systemic treatment [immunotherapy (IT) or targeted therapy (TT)] carried out after the BM diagnosis (HR = 1.033, 95% CI 0.565-1.889, P = 0.16), and revealed that external radiation therapy (eRT) significantly prolonged iPFS when combined with IT (10.7 months, 95% CI 4.9-48 months, P = 0.0321) and not when combined with TT (9.01 months, 95% CI 2.7-21.2 months, P = 0.59).
Our results suggest a potential additive effect in terms of iPFS for eRT combined with IT and encourage a more intensive multimodal therapeutic strategy in a multidisciplinary context to improve the survival of BMRCC patients.
尽管最近的治疗策略显著延长了肾细胞癌（RCC）患者的预期寿命，但治疗脑转移 RCC（BMRCC）患者仍然是一个未满足的临床需求。我们的多中心、回顾性、观察性研究调查了来自 22 家意大利机构的 RCC 脑转移（BM）患者的真实世界队列。
共纳入 226 名组织学诊断为 RCC 且影像学证实有 BM 的患者。使用单变量和多变量模型来研究临床病理特征和多模式治疗对 BM 诊断后总生存期（OS）和颅内无进展生存期（iPFS）的影响。
BM 诊断后的中位 OS 为 18.8 个月（四分位距：6.2-43 个月）。多变量分析证实以下因素为阳性独立预后因素：卡氏功能状态评分>70%（风险比 [HR] = 0.49，95%置信区间 [CI] 0.26-0.92，P = 0.0026）和单发 BM（HR = 0.51，95%CI 0.31-0.86，P = 0.0310）；相反，以下因素被确认为预后较差的因素：进展性颅外疾病（HR = 1.66，95%CI 1.003-2.74，P = 0.00181）和 BM 发生后仅进行一线系统治疗（HR = 2.98，95%CI 1.62-5.49，P = 0.029）。亚组分析显示，BM 诊断后进行的一线系统治疗（免疫治疗 [IT] 或靶向治疗 [TT]）类型对 iPFS 无差异（HR = 1.033，95%CI 0.565-1.889，P = 0.16），并表明体外放射治疗（eRT）与 IT 联合使用可显著延长 iPFS（10.7 个月，95%CI 4.9-48 个月，P = 0.0321），与 TT 联合使用则无此效果（9.01 个月，95%CI 2.7-21.2 个月，P = 0.59）。
我们的结果表明，eRT 联合 IT 在 iPFS 方面可能具有潜在的附加作用，并鼓励在多学科背景下采用更强化的多模式治疗策略，以改善 BMRCC 患者的生存。
