title: Brain metastasis from renal cell carcinoma.
abstract: BACKGROUND
  Patients with brain metastasis (BM) from renal cell carcinoma (RCC) have a poorly known prognosis due to the rarity of this disease. The aim of our study was to assess the outcome of patients with a BM due to RCC, and to determine the predictive factors for survival.
  
  
  METHODS
  Consecutive patients who underwent treatment between 1997 and 2012 were identified retrospectively from a database (n=28, median age of 57.8 years, sex ratio M/F: 3.7). Main criteria collected concerned survival time. Other data collected were relative to initial histology, clinical findings at the time of BM diagnosis (diagnosis circumstances, KPS), radiological findings and BM characteristics (number, size and localization), treatment of BM (including surgery, stereotactic radiosurgery [SRS], systemic treatments, whole brain radiotherapy [WBRT]) and the outcome of surgery if performed. Statistical analysis of survival was performed using the Kaplan-Meier method.
  
  
  RESULTS
  Median survival was 13.3 months, 1-year survival was 60.2%, 2-year survival was 16.4%. Univariate analysis showed the existence of intracranial hypertension (P=0.01), other systemic metastasis (P=0.049), the absence of deep metastasis (P=0.03) which are all linked to shorter survival. Age, KPS, initial histology of RCC, number, size, localization, and hemorrhage in BM were not correlated to survival. The median survival in the surgical resection group was 25.3 months versus 8.6 months (P=0.02). The main criteria for the selection of the surgical group were a single BM (P=0.04), and superficial metastasis (P=0.02).
  
  
  CONCLUSIONS
  Three predictive factors for longer survival in BMRCC were the absence of intracranial hypertension, the absence of acute metastasis and the absence of extracranial metastasis. Surgical removal, when possible, seems to benefit patient survival.
authors.affiliation: Service de neurochirurgie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Service de neurologie, CHU de Rouen, 76031 Rouen, France. Electronic address: bennanio@gmail.com.
authors.forename: O
authors.initials: O
authors.lastname: Bennani
authors.affiliation: Service de neurochirurgie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Derrey
authors.affiliation: Service de neurochirurgie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: O
authors.initials: O
authors.lastname: Langlois
authors.affiliation: U982 Inserm, Astrocyte and Vascular Niche, DC2N, université de Rouen, 76821 Mont-Saint-Aignan, France.
authors.forename: H
authors.initials: H
authors.lastname: Castel
authors.affiliation: Service d'anatomopathologie, CHU de Rouen, 76031 Rouen, France.
authors.forename: A
authors.initials: A
authors.lastname: Laquerriere
authors.affiliation: Service de neurochirurgie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Freger
authors.affiliation: Service de neurochirurgie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Proust
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies
keywords: Brain metastasis; Cancer du rein; Facteur pronostique; Métastase cérébrale; Prognostic factor; Renal cell carcinoma