title: Impact of resection and systemic therapy on the survival of patients with brain metastasis of metastatic renal cell carcinoma.
abstract: Patients with brain metastasis (BM) from renal cell carcinoma (RCC) are associated with poor prognosis. Between 1990 and 2015, data of consecutive RCC patients with BM were retrospectively analyzed from a urologic oncologic database. The treatment outcome was evaluated by overall survival (OS), which was defined as interval from initial diagnosis of BM to death or last follow-up. Statistical analyses of clinical and pathological variables were performed using Cox regression and the Kaplan-Meier method. A total of 116 RCC patients with BM were included. Median time from initial diagnosis of RCC to BM was 15.8 months (95 % CI 11.6-20.0). Median OS after diagnosis of brain metastases of the whole cohort was 5.8 months (95 % CI 4.3-7.2). On multivariate Cox regression analysis, age and histology of non-clear cell RCC were associated with poorer outcome, while targeted therapy (n = 26) (OS 9.9 months, 95 % CI 3.3-16.5) and BM resection (n = 33) (OS 24.7 months, 95 % CI 4-40) were associated with better survival. Furthermore, patients who underwent both targeted therapy and BM resection (n = 5) had the best outcome with median OS of 52.4 months. In conclusion, BM from RCC is associated with a poor oncological outcome. Furthermore, age and histology of non-clear cell RCC are risk factors for poor prognosis. Patients with resectable BM may comprise a better prognostic group. Here, a better OS for resected than unresected patients was observed, which warrants BM resection. A combined modality approach of resection and targeted therapy appears to further improve the outcome of these patients while additional radiation seems to add no benefit.
authors.affiliation: Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, Germany.|Department of Urology, Nanfang Hospital of Southern Medical University, Guangzhou, China.
authors.forename: YueJun
authors.initials: Y
authors.lastname: Du
authors.affiliation: Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, Germany. sascha.pahernik@klinikum-nuernberg.de.|Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Prof.-Ernst-Nathan-Str. 1, Nuremberg, Germany. sascha.pahernik@klinikum-nuernberg.de.
authors.forename: Sascha
authors.initials: S
authors.lastname: Pahernik
authors.affiliation: Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Hadaschik
authors.affiliation: Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, Germany.
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
authors.affiliation: Section of Molecular Urooncology, Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Duensing
authors.affiliation: Department of Medical Oncology, Heidelberg University Hospital, National Center for Tumor Diseases Heidelberg, Im Neuenheimer Feld 460, Heidelberg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Jäger
authors.affiliation: Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
authors.affiliation: Department of Medical Oncology, Heidelberg University Hospital, National Center for Tumor Diseases Heidelberg, Im Neuenheimer Feld 460, Heidelberg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Grüllich
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brain metastasis; Prognosis; Renal cell cancer; Survival; Targeted therapy