Construction and Validation of a Convenient Clinical Nomogram to Predict the Risk of Brain Metastasis in Renal Cell Carcinoma Patients

Abstract

Brain metastasis (BM) is a typical type of metastasis in renal cell carcinoma (RCC) patients. The early detection of BM is likely a crucial step for RCC patients to receive appropriate treatment and prolong their overall survival. The aim of this study was to identify the independent predictors of BM and construct a nomogram to predict the risk of BM. Demographic and clinicopathological data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database for RCC patients between 2010 and 2015. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors, and then, a visual nomogram was constructed. Multiple parameters were used to evaluate the discrimination and clinical value. We finally included 42577 RCC patients. Multivariate logistic regression analysis showed that histological type, tumor size, bone metastatic status, and lung metastatic status were independent BM-associated risk factors for RCC. We developed a nomogram to predict the risk of BM in patients with RCC, which showed favorable calibration with a C -index of 0.924 (0.903-0.945) in the training cohort and 0.911 (0.871-0.952) in the validation cohort. The calibration curves and decision curve analysis (DCA) also demonstrated the reliability and accuracy of the clinical prediction model. The nomogram was shown to be a practical, precise, and personalized clinical tool for identifying the RCC patients with a high risk of BM, which not only will contribute to the more reasonable allocation of medical resources but will also enable a further improvements in the prognosis and quality of life of RCC patients.

Construction and validation of nomogram to predict distant metastasis in osteosarcoma: a retrospective study

“…The nomogram is a statistical tool; it can combine all independent risk factors to evaluate the endpoint accident in which we are interested. Nowadays, nomograms have been widely applied to predict the metastasis of other cancer patients such as renal cell carcinoma [ 9 ], gastrointestinal stromal tumor [ 10 ], and thyroid carcinoma [ 11 ].…”

Editorial Comment from Dr Hatakeyama and Dr Ohyama to Clinical utility of head computed tomography scan during systemic therapy for metastatic renal cell carcinoma

“…In this study, Naito et al retrospectively examined the benefits of routine BM screening using computed tomography (CT) in the era of targeted therapy. 3 They showed that routine head CT significantly decreased the incidence of craniotomy, possibly indicating that the size of BMs at the time of diagnosis was larger in the non-screening group. However, no survival benefit was detected from the routine BM screening, as previously reported in the literature.…”

“…The alternative strategy is the risk‐based approach to detecting brain metastasis. A recent study investigated the risk factors for brain metastasis, including 42 577 patients with RCC using the Surveillance, Epidemiology, and End Results (SEER) database 3 . The authors of that study found that histological type (clear cell carcinoma), tumor size (larger), bone metastasis (positive), and lung metastasis (positive) were independent risk factors for brain metastasis.…”

Multidiscipline Immunotherapy-Based Rational Combinations for Robust and Durable Efficacy in Brain Metastases from Renal Cell Carcinoma

“…Brain metastases (BM) is generally associated with a very poor prognosis and high degree of morbidity, requiring urgent multidisciplinary care, and is relatively unresponsive to conventional systemic therapy [11,[16][17][18][19][20][21][22][23][24][25]. BM is also a serious condition that causes headaches, focal neurological deficits, altered mental status or gradual cognitive impairment, epileptic seizures driven by increased intracranial pressure by vasogenic edema, or alterations in cerebrospinal fluid (CSF) flow, thereby impairing the quality of life (QOL) [11,[17][18][19][25][26][27]. Unfortunately, BM is not a rare finding in mRCC (8%-15%), and its prevalence has increased in the past two decades [16][17][18][19][20][21][22].…”

“…The median OS of RCC patients with BM (RCC-BM) is only 5-8 months [16][17][18][19][20][21][22]. Therefore, early detection and effective treatment of BM is an unmet medical need for mRCC [11,17,19,25]. Improved clinical outcomes of extracranial metastases by the introduction of TKIs and immune checkpoint inhibitors (ICIs) has led to the adoption of improved imaging techniques for BM, thereby increasing awareness of the benefit of brain screening [11,[17][18][19][20]27].…”