Do renal cell carcinoma patients with brain metastases still need nephrectomy?
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To evaluate the value of nephrectomy for survival prognosis in renal cell carcinoma (RCC) patients with brain metastases (BM).
There were 933 RCC patients diagnosed with BM in SEER database from 2010 to 2014. Kaplan–Meier method and Cox regression model were used to analyze the survival prognosis. The effect of nephrectomy on overall survival (OS) was analyzed by propensity score matching. The competitive risk model was performed to explore the relationship between surgery and cancer-specific survival (CSS), and the nomogram visualization model was established by R language to predict survival rate.
BM accounted for 1.5% of newly diagnosed RCC patients and 11.1% of M1 stage patients with the median survival time of 5 months (95% CI 4.5–5.5). Age 45–65 years, tumor diameter > 10 cm and histologic type of clear cell renal cell carcinoma (ccRCC) were high risk factors for BM in RCC patients. Age, N stage, lung metastasis and nephrectomy were independent prognostic factors. Nephrectomy was beneficial for both OS and CSS for the analysis of 216 patients successfully matched. The nomogram model has a certain value in predicting the survival rate with the internal verification c-index of 0.727.
Patients with high risk of BM (age 45–65 years, tumor diameter > 10 cm, histologic type of ccRCC) should emphasize brain imaging screening during follow-up. Nephrectomy may bring survival advantages for RCC patients with BM. Nomogram model based on nephrectomy can helps predicting the 1-, 2- and 3-year survival rates.
KeywordsBrain metastases Renal cell carcinoma Nephrectomy Epidemiology Survival
The authors would like to thank the SEER program for public access to the database.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. We obtained the authorization to access the SEER database, with the number 14260-Nov 2016.
The SEER database does not reveal patient privacy, so patient informed consent is not required.
- 3.Sun M, De Velasco G, Brastianos PK et al (2018) The development of brain metastases in patients with renal cell carcinoma: epidemiologic trends, survival, and clinical risk factors using a population-based cohort. Eur Urol Focus 428:1–8Google Scholar
- 10.Huang F, Du C, Sun M et al (2015) Propensity score matching in SPSS. Nan Fang Yi Ke Da Xue Xue Bao 35:1597–1601Google Scholar
- 23.Koo KC, Lee KS, Cho KS et al (2016) Comprehensive analysis and validation of contemporary survival prognosticators in Korean patients with metastatic renal cell carcinoma treated with targeted therapy: prognostic impact of pretreatment neutrophil-to-lymphocyte ratio. Int Urol Nephrol 48:985–992CrossRefGoogle Scholar