Culine S, Bekradda M, Kramar A, Rey A, Escudier B, Droz J P
Department of Medicine, Institut Gustave Roussy, Villejuif, France.
Cancer. 1998 Dec 15;83(12):2548-53.
Patients presenting with brain metastases from renal cell carcinoma portend a poor prognosis, with a reported median survival of 4-6 months. Given their short life expectancy, these patients generally have been excluded from clinical trials that assess the efficacy of medical treatments. However, clinical impression suggests that some patients may achieve long term palliation.
The clinical features of 68 patients who were treated at the Institut Gustave Roussy for brain metastases from renal cell carcinoma were collected retrospectively. Using univariate and multivariate analyses, a prognostic model based on independent prognostic factors was established. An external data set of 57 patients was used to validate the model.
The median survival was 7 months. On univariate analysis survival was related significantly to the following adverse prognostic factors: no initial nephrectomy, left side and temporal location of brain metastases, presence of fever or weight loss, erythrocyte sedimentation rate > 50 mm/h, and time from initial diagnosis to brain metastases < or = 18 months. Multivariate analyses identified the previous variable as well as the presence of other visceral metastases as independent prognostic factors. Forty-four patients (65%) with no or 1 adverse prognostic factor (average risk group) had a median survival of 8 months and a 26% 1-year survival rate. Twenty-four patients (35%) with 2 adverse prognostic factors (poor risk group) had a median survival of 3 months and a 1-year survival rate of 9%. This model proved to be discriminant in an external data set; the median survival of patients assigned to the average risk group was 11 months (46% 1-year survival rate) compared with 4 months (9% 1-year survival rate) for patients assigned to the poor risk group.
Patients presenting with brain metastases from renal cell carcinoma and poor risk prognostic factors are highly unlikely to benefit from medical treatments except symptomatic procedures. Conversely, the enrollment of patients with average risk prognostic factors into clinical trials dealing with chemotherapy or immunotherapy may be considered.
肾细胞癌脑转移患者预后较差，报道的中位生存期为4至6个月。鉴于其预期寿命较短，这些患者通常被排除在评估药物治疗疗效的临床试验之外。然而，临床观察表明，一些患者可能实现长期姑息治疗。
回顾性收集在古斯塔夫·鲁西研究所接受治疗的68例肾细胞癌脑转移患者的临床特征。通过单因素和多因素分析，建立基于独立预后因素的预后模型。使用57例患者的外部数据集对该模型进行验证。
中位生存期为7个月。单因素分析显示，生存期与以下不良预后因素显著相关：未行初始肾切除术、脑转移位于左侧和颞叶、存在发热或体重减轻、红细胞沉降率>50mm/h以及从初始诊断至发生脑转移的时间≤18个月。多因素分析确定上述变量以及存在其他内脏转移为独立预后因素。44例（65%）无或有1个不良预后因素的患者（平均风险组）中位生存期为8个月，1年生存率为26%。24例（35%）有2个不良预后因素的患者（高风险组）中位生存期为3个月，1年生存率为9%。该模型在外部数据集中具有判别能力；平均风险组患者的中位生存期为11个月（1年生存率46%），而高风险组患者为4个月（1年生存率9%）。
肾细胞癌脑转移且具有高风险预后因素的患者除对症治疗外极不可能从药物治疗中获益。相反，可考虑将具有平均风险预后因素的患者纳入化疗或免疫治疗的临床试验。
