Takemura Kosuke, Lemelin Audreylie, Ernst Matthew S, Wells J Connor, Saliby Renee Maria, El Zarif Talal, Labaki Chris, Basappa Naveen S, Szabados Bernadett, Powles Thomas, Davis Ian D, Wood Lori A, Lalani Aly-Khan A, McKay Rana R, Lee Jae-Lyun, Meza Luis, Pal Sumanta K, Donskov Frede, Yuasa Takeshi, Beuselinck Benoit, Gebrael Georges, Agarwal Neeraj, Choueiri Toni K, Heng Daniel Y C
Tom Baker Cancer Centre, University of Calgary, Calgary, Canada; Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Tom Baker Cancer Centre, University of Calgary, Calgary, Canada.
Eur Urol. 2024 Dec;86(6):488-492. doi: 10.1016/j.eururo.2024.01.006. Epub 2024 Jan 29.
Patients with brain metastases (BrM) from renal cell carcinoma and their outcomes are not well characterized owing to frequent exclusion of this population from clinical trials. We analyzed data for patients with or without BrM using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC). A total of 389/4799 patients (8.1%) had BrM on initiation of systemic therapy. First-line immuno-oncology (IO)-based combination therapy was associated with longer median overall survival (OS; 32.7 mo, 95% confidence interval [CI] 22.3-not reached) versus tyrosine kinase inhibitor monotherapy (20.6 mo, 95% CI 15.7-24.5; p = 0.019), as were intensive focal therapies with stereotactic radiotherapy or neurosurgery (31.4 mo, 95% CI 22.3-37.5) versus whole-brain radiotherapy alone or no focal therapy (16.5 mo, 95% CI 10.2-21.1; p = 0.028). On multivariable analysis, IO-based regimens (HR 0.49, 95% CI 0.25-0.97; p = 0.040) and stereotactic radiotherapy or neurosurgery (HR 0.48, 95% CI 0.29-0.78; p = 0.003) were independently associated with longer OS, as was IMDC favorable or intermediate risk (HR 0.40, 95% CI 0.24-0.66; p < 0.001). Intensive systemic and focal therapies were associated with better prognosis in this population. Further studies should explore the clinical effectiveness of multimodal strategies. PATIENT SUMMARY: In a large group of patients with advanced kidney cancer, we found that 8.1% had brain metastases when starting systemic therapy. Patients with brain metastases had significantly poorer prognosis than those without brain metastases. Receipt of combination immunotherapy, stereotactic radiotherapy, or neurosurgery was associated with longer overall survival.
由于临床试验经常将这部分人群排除在外，肾细胞癌脑转移（BrM）患者及其预后情况尚未得到充分描述。我们使用国际转移性肾细胞癌数据库联盟（IMDC）分析了有或无脑转移患者的数据。共有389/4799例患者（8.1%）在开始全身治疗时存在脑转移。与酪氨酸激酶抑制剂单药治疗相比，一线免疫肿瘤学（IO）联合治疗的中位总生存期（OS）更长（32.7个月，95%置信区间[CI] 22.3 - 未达到）（20.6个月，95% CI 15.7 - 24.5；p = 0.019），立体定向放射治疗或神经外科等强化局部治疗也是如此（31.4个月，95% CI 22.3 - 37.5），而单纯全脑放疗或无局部治疗的患者中位总生存期为16.5个月（95% CI 10.2 - 21.1；p = 0.028）。多变量分析显示，基于IO的方案（HR 0.49，95% CI 0.25 - 0.97；p = 0.040）、立体定向放射治疗或神经外科（HR 0.48，95% CI 0.29 - 0.78；p = 0.003）与更长的总生存期独立相关，IMDC有利或中度风险也是如此（HR 0.40，95% CI 0.24 - 0.66；p < 0.001）。强化全身和局部治疗与该人群更好的预后相关。进一步研究应探索多模式策略的临床有效性。患者总结：在一大组晚期肾癌患者中，我们发现8.1%的患者在开始全身治疗时存在脑转移。有脑转移的患者预后明显比无脑转移的患者差。接受联合免疫治疗、立体定向放射治疗或神经外科治疗与更长的总生存期相关。
