Do renal cell carcinoma patients with brain metastases still need nephrectomy?

  • Wei Zhuang
  • Yining Li
  • Panyu Chen
  • Jialiang Wang
  • Weihui Liu
  • Jiabi ChenEmail author
Urology - Original Paper



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.


Brain 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.

Ethical approval

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.

Informed consent

The SEER database does not reveal patient privacy, so patient informed consent is not required.


  1. 1.
    Cagney DN, Martin AM, Catalano PJ et al (2017) Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study. Neuro Oncol 19:1511–1521CrossRefGoogle Scholar
  2. 2.
    Davis FG, Dolecek TA, McCarthy BJ et al (2012) Toward determining the lifetime occurrence of metastatic brain tumors estimated from 2007 United States cancer incidence data. Neuro Oncol 14:1171–1177CrossRefGoogle Scholar
  3. 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
  4. 4.
    Patil S, Manola J, Elson P et al (2012) Improvement in overall survival of patients with advanced renal cell carcinoma: prognostic factor trend analysis from an international data set of clinical trials. J Urol 188:2095–2100CrossRefGoogle Scholar
  5. 5.
    Heng DY, Xie W, Regan MM et al (2013) External validation and comparison with other models of the International Metastatic Renal-Cell Carcinoma Database Consortium prognostic model: a population-based study. Lancet Oncol 14:141–148CrossRefGoogle Scholar
  6. 6.
    Brahmer JR, Tykodi SS, Chow LQ et al (2012) Safety and activity of anti-PD-L1 antibody in patients with advanced cancer. N Engl J Med 366:2455–2465CrossRefGoogle Scholar
  7. 7.
    Hellenthal NJ, Mansour AM, Hayn MH et al (2013) Is there a role for partial nephrectomy in patients with metastatic renal cell carcinoma. Urol Oncol 31:36–41CrossRefGoogle Scholar
  8. 8.
    Xiao WJ, Zhu Y, Dai B et al (2015) Assessment of survival of patients with metastatic clear cell renal cell carcinoma after radical cytoreductive nephrectomy versus no surgery: a seer analysis. Int Braz J Urol 41:288–295CrossRefGoogle Scholar
  9. 9.
    Iasonos A, Schrag D, Raj GV et al (2008) How to build and interpret a nomogram for cancer prognosis. J Clin Oncol 26:1364–1370CrossRefGoogle Scholar
  10. 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
  11. 11.
    Scrucca L, Santucci A, Aversa F (2007) Competing risk analysis using R: an easy guide for clinicians. Bone Marrow Transplant 40:381–387CrossRefGoogle Scholar
  12. 12.
    Remon J, Lianes P, Martínez S (2012) Brain metastases from renal cell carcinoma. Should we change the current standard. Cancer Treat Rev 38:249–257CrossRefGoogle Scholar
  13. 13.
    Sperduto PW, Chao ST, Sneed PK et al (2010) Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4259 patients. Int J Radiat Oncol Biol Phys 77:655–661CrossRefGoogle Scholar
  14. 14.
    Patchell RA, Tibbs PA, Walsh JW et al (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500CrossRefGoogle Scholar
  15. 15.
    Vecht CJ, Haaxma-Reiche H, Noordijk EM et al (1993) Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery. Ann Neurol 33:583–590CrossRefGoogle Scholar
  16. 16.
    Tonyali S, Yazici S (2016) Does solitary- and organ-confined metastasectomy really improve survival in advanced urologic malignancies. Int Urol Nephrol 48:671–680CrossRefGoogle Scholar
  17. 17.
    Meyer CP, Sun M, Karam JA et al (2017) Complications after metastasectomy for renal cell carcinoma-a population-based assessment. Eur Urol 72:171–174CrossRefGoogle Scholar
  18. 18.
    Mintz AH, Kestle J, Rathbone MP et al (1996) A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis. Cancer 78:1470–1476CrossRefGoogle Scholar
  19. 19.
    Capitanio U, Zini L, Perrotte P et al (2008) Cytoreductive partial nephrectomy does not undermine cancer control in metastatic renal cell carcinoma: a population-based study. Urology 72:1090–1095CrossRefGoogle Scholar
  20. 20.
    Dreicer R, Galbraith SS, Davis CS et al (1997) Surgical resection of metastatic renal cell carcinoma: the University of Iowa experience. Urol Oncol 3:99–101CrossRefGoogle Scholar
  21. 21.
    Culp SH, Karam JA, Wood CG (2014) Population-based analysis of factors associated with survival in patients undergoing cytoreductive nephrectomy in the targeted therapy era. Urol Oncol 32:561–568CrossRefGoogle Scholar
  22. 22.
    Karakiewicz PI, Suardi N, Capitanio U et al (2009) A preoperative prognostic model for patients treated with nephrectomy for renal cell carcinoma. Eur Urol 55:287–295CrossRefGoogle Scholar
  23. 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

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© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of UrologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
  2. 2.Department of Clinical Medicine ScienceThe Second Clinical Medical School of Fujian Medical UniversityQuanzhouChina

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