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Synchronous brain metastases as a poor prognosis factor in clear cell renal carcinoma: a strong argument for systematic brain screening

  • Clinical Study
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Abstract

Purpose

Brain metastases (BM) usually represent a poor prognostic factor in solid tumors. About 10% of patients with renal cancer (RCC) will present BM. Local therapies such as stereotactic radiotherapy (SRT), whole brain radiotherapy (WBRT), and surgery are used to achieve brain control. We compared survival between patients with synchronous BM (SynBM group) and metachronous BM (MetaBM group).

Methods

It is a retrospective study of patients with clear cell renal cell carcinoma (ccRCC) and BM treated with TKI between 2005 and 2019 at the Centre Léon Bérard in Lyon. We collected prognostic factors: The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk score, the TNM stage, the histological subtypes and the Fuhrman grade. Overall survival (OS) was defined from diagnosis of metastatic ccRCC to death. Brain progression-free survival (B-PFS) was defined from focal brain therapy to brain progression or death.

Results

99 patients were analyzed, 44 in the SynBM group and 55 in the MetaBM group. OS in the MetaBM group was 49.4 months versus 19.6 months in the SynBM group, p = 0.0002. The median time from diagnosis of metastasic disease to apparition of BM in the MetaBM group was 22.9 months (4.3; 125.7). SRT was used for 101 lesions (66.4%), WBRT for 25 patients (16.4%), surgery for 21 lesions (13.8%), surgery followed by radiation for 5 lesions (3.3%). B-PFS for all patients was 7 months (IC95% [5.0–10.5]).

Conclusions

Survival of patients with synchronous BM is inferior to that of patients with metachronous BM. Outcome is poor in both cases after diagnosis of BM. Brain screening should be encouraged at time of diagnosis of metastatis in ccRCC.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

Aude Fléchon:- Honoraria and personal fees from BMS, IPSEN, ROCHE, PFIZER, MSD. Sylvie Négrier:—research grant, personal fees and non-financial support from PFIZER,—personal fees and non-financial support from BMS,—research grant, personal fees and non-financial support from IPSEN,—personal fees from NOVARTIS,—personal fees and non-financial support from MSD. Helen Boyle:—Travel expenses from BMS, Pfizer, Janssen, Astellas, Sanofi, Ipsen—Honoraria from Sanofi, Novartis, Janssen, Ipsen, Pfizer. Eve-Marie Neidhart:—Honoraria and personal fees from NOVARTIS, BMS, MSD. Other authors have no financial disclosure.

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Authors and Affiliations

  1. Centre Léon Bérard, 28 Prom. Lea et Napoleon Bullukian, 69008, Lyon, France

    Valentine Ruste, Marie Pierre Sunyach, Ronan Tanguy, Camille Schiffler, Eve-Marie Neidhardt, Helen Boyle, Sophie Robin, Sylvie Négrier & Aude Fléchon

  2. Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France

    Emmanuel Jouanneau & Sylvie Négrier

  3. Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France

    Emmanuel Jouanneau

  4. Centre Hospitalier Annecy Genevois, 1 avenue de l’hôpital, 74370, Epagny Metz-Tessy, France

    Mélodie Carbonnaux

  5. Centre hospitalier Métropole Savoie, place Lucien Biset, 73000, Chambéry, France

    Guillaume Moriceau

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  1. Valentine Ruste
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Contributions

Conception and design: VR, AF. Acquisition of data: VR, MC, GM, MPS, RT, HB, EMN, EJ, AF, SN. Analysis and interpretation of data: VR, AF. Drafting of the manuscript: VR, AF, SN, SR. Stastistical analysis: CS, VR. Supervision: AF, SN.

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Correspondence to Valentine Ruste.

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Ruste, V., Sunyach, M.P., Tanguy, R. et al. Synchronous brain metastases as a poor prognosis factor in clear cell renal carcinoma: a strong argument for systematic brain screening. J Neurooncol 153, 133–141 (2021). https://doi.org/10.1007/s11060-021-03751-5

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  • DOI: https://doi.org/10.1007/s11060-021-03751-5

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