Prognostic factors for survival in metastatic renal cell carcinoma patients with brain metastases receiving targeted therapy

Abstract

Background The primary objective of our study was to examine the clinical outcomes and prognosis of patients with metastatic renal cell carcinoma (mRCC) with brain metastases (BMs) receiving targeted therapy. Patients and methods Fifty-eight patients from 16 oncology centers for whom complete clinical data were available were retrospectively reviewed. Results The median age was 57 years (range 30-80). Most patients underwent a nephrectomy (n = 41; 70.7%), were male (n = 42; 72.4%) and had clear-cell (CC) RCC (n = 51; 87.9%). Patients were treated with first-line sunitinib (n = 45; 77.6%) or pazopanib (n = 13; 22.4%). The median time from the initial RCC diagnosis to the diagnosis of BMs was 9 months. The median time from the first occurrence of metastasis to the development of BMs was 7 months. The median overall survival (OS) of mRCC patients with BMs was 13 months. Time from the initial diagnosis of systemic metastasis to the development of BMs (<12 months; p = 0.001), histological subtype (non-CC; p<0.05) and number of BMs (≥2; p<0.05) were significantly associated with OS in multivariate analysis. There were no cases of toxic death. One mRCC patient with BMs (1.7%) experienced treatment-related cerebral necrosis. All other toxicities included those commonly observed with VEGF-TKI therapy. Conclusions The time from the initial diagnosis of systemic metastasis to the development of BMs (<12 months), a non-CC histological subtype, and a greater number of BMs (≥2) were independent risk factors for a poor prognosis.

Validation of the updated renal graded prognostic assessment (GPA) for patients with renal cancer brain metastases treated with gamma knife radiosurgery

“…The predictive value of age has also been reported in prior cohorts [24,26]. In addition, extended OS was predicted by longer time from primary diagnosis to brain metastasis, which has been reported before [24,26,27].…”

The value of cytoreductive nephrectomy on the survival of metastatic renal carcinoma patients based on the number of site-specific metastases

“…These stringent inclusion and exclusion criteria mean that upcoming results from these trials will not provide data that are generalizable to real world practice. Several studies have focused on the survival outcomes in patients with metastases in the bone[9,19], liver[19], lung[20], and brain[21,22] and higher tumor grades [23], and found them as negative predictors of OS. However, no study paid attention to the important role of the number of metastatic sites on the prognosis of patients with mRCC.…”

Comprehensive Systematic Review of Biomarkers in Metastatic Renal Cell Carcinoma: Predictors, Prognostics, and Therapeutic Monitoring

“…They identified several factors, including Karnofsky performance status, number of brain metastases, and time to brain metastases, as independent predictors of survival. These findings contribute to the understanding of prognostic factors specific to mRCC patients with brain metastases, aiding in treatment planning and patient management [126].…”