Original Study| Volume 15, ISSUE 6, P717-723, December 2017

Prognostic Factors for Survival of Patients With Synchronous or Metachronous Brain Metastasis of Renal Cell Carcinoma



      We evaluated the oncological outcomes of synchronous or metachronous brain metastasis (BM) of metastatic renal cell carcinoma (RCC) according to clinicopathologic factors.

      Patients and Methods

      Patients with metastatic RCC (n = 93) with synchronous and metachronous BM were retrospectively identified. We analyzed patients and tumor characteristics, treatment methods, prognostic factors, BM progression, and overall survival (OS).


      Seventy-six patients (81.7%) received local therapy (stereotactic radiosurgery [60.2%], radiation therapy [22.6%], and neurosurgery [10.8%]), and 54 patients (58.1%) were treated with systemic medical therapy. In multivariable analysis, poor Memorial Sloan-Kettering Cancer Center (MSKCC) risk (hazard ratio [HR] 3.672; 95% confidence interval [CI], 1.441-9.36; P = .0064), sarcomatoid component (HR 4.264; 95% CI, 2.062-8.820; P = .0001), and multiple BMs (HR 2.838; 95% CI, 1.690-4.767; P = .0001) were prognostic indicators of a poorer OS outcome. Local (HR 0.436; 95% CI, 0.237-0.802; P = .0076) and systemic treatment (HR 0.322; 95% CI, 0.190-0.548; P < .0001) were independent factors for a better OS. Although OS from initial RCC diagnosis in patients with metachronous BM was better than that for patients with synchronous BM, there were no differences found between synchronous and metachronous patients in terms of BM progression and OS after the diagnosis of BM.


      Poor MSKCC risk, sarcomatoid component of histology, and multiple BMs are prognostic indicators for poor OS in patients with BM from metastatic RCC. Systemic and/or local treatment improves the OS. Because the type of BM, synchronous or metachronous, does not influence BM progression or the OS outcome, routine evaluation for BM is not recommended.


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        • Athar U.
        • Gentile T.C.
        Treatment options for metastatic renal cell carcinoma: a review.
        Can J Urol. 2008; 15: 3954-3966
        • Bianchi M.
        • Sun M.
        • Jeldres C.
        • et al.
        Distribution of metastatic sites in renal cell carcinoma: a population-based analysis.
        Ann Oncol. 2012; 23: 973-980
        • Levy D.A.
        • Slaton J.W.
        • Swanson D.A.
        • Dinney C.P.
        Stage specific guidelines for surveillance after radical nephrectomy for local renal cell carcinoma.
        J Urol. 1998; 159: 1163-1167
        • Schouten L.J.
        • Rutten J.
        • Huveneers H.A.
        • Twijnstra A.
        Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma.
        Cancer. 2002; 94: 2698-2705
        • Wronski M.
        • Maor M.H.
        • Davis B.J.
        • Sawaya R.
        • Levin V.A.
        External radiation of brain metastases from renal carcinoma: a retrospective study of 119 patients from the M. D. Anderson Cancer Center.
        Int J Radiat Oncol Biol Phys. 1997; 37: 753-759
        • Medioni J.
        • Cojocarasu O.
        • Belcaceres J.L.
        • Halimi P.
        • Oudard S.
        Complete cerebral response with sunitinib for metastatic renal cell carcinoma.
        Ann Oncol. 2007; 18: 1282-1283
        • Lim Z.D.
        • Mahajan A.
        • Weinberg J.
        • Tannir N.M.
        Outcome of patients with renal cell carcinoma metastatic to the brain treated with sunitinib without local therapy.
        Am J Clin Oncol. 2013; 36: 258-260
        • Chevreau C.
        • Ravaud A.
        • Escudier B.
        • et al.
        A phase II trial of sunitinib in patients with renal cell cancer and untreated brain metastases.
        Clin Genitourin Cancer. 2014; 12: 50-54
        • Grullich C.
        • Vallet S.
        • Hecht C.
        • et al.
        Local salvage therapy for late (>/=2 years) metastatic and local relapse of renal cell cancer is a potentially curative treatment irrespective of the site of recurrence.
        Urol Oncol. 2016; 34 (e9-17): 238
        • Remon J.
        • Lianes P.
        • Martinez S.
        Brain metastases from renal cell carcinoma. Should we change the current standard?.
        Cancer Treat Rev. 2012; 38: 249-257
        • Meimarakis G.
        • Angele M.
        • Staehler M.
        • et al.
        Evaluation of a new prognostic score (Munich score) to predict long-term survival after resection of pulmonary renal cell carcinoma metastases.
        Am J Surg. 2011; 202: 158-167
        • Kwak C.
        • Park Y.H.
        • Jeong C.W.
        • Jeong H.
        • Lee S.E.
        • Ku J.H.
        Characteristics of metastasis as a prognostic factor for immunotherapy in metastatic renal cell carcinoma.
        Tumori. 2007; 93: 68-74
        • Kim H.
        • Jung T.Y.
        • Kim I.Y.
        • Jung S.
        • Moon K.S.
        • Park S.J.
        The usefulness of stereotactic radiosurgery for radioresistant brain metastases.
        J Korean Neurosurg Soc. 2013; 54: 107-111
        • Gavrilovic I.T.
        • Posner J.B.
        Brain metastases: epidemiology and pathophysiology.
        J Neurooncol. 2005; 75: 5-14
        • Shuch B.
        • La Rochelle J.C.
        • Klatte T.
        • et al.
        Brain metastasis from renal cell carcinoma: presentation, recurrence, and survival.
        Cancer. 2008; 113: 1641-1648
        • Motzer R.J.
        • Hutson T.E.
        • Tomczak P.
        • et al.
        Sunitinib versus interferon alfa in metastatic renal-cell carcinoma.
        N Engl J Med. 2007; 356: 115-124
        • Bastos D.A.
        • Molina A.M.
        • Hatzoglou V.
        • et al.
        Safety and efficacy of targeted therapy for renal cell carcinoma with brain metastasis.
        Clin Genitourin Cancer. 2015; 13: 59-66
        • Verma J.
        • Jonasch E.
        • Allen P.
        • Tannir N.
        • Mahajan A.
        Impact of tyrosine kinase inhibitors on the incidence of brain metastasis in metastatic renal cell carcinoma.
        Cancer. 2011; 117: 4958-4965
        • Tabouret E.
        • Bauchet L.
        • Carpentier A.F.
        Brain metastases epidemiology and biology.
        Bull Cancer. 2013; 100 ([in French]): 57-62
        • Minocha M.
        • Khurana V.
        • Mitra A.K.
        Determination of pazopanib (GW-786034) in mouse plasma and brain tissue by liquid chromatography-tandem mass spectrometry (LC/MS-MS).
        J Chromatogr B Analyt Technol Biomed Life Sci. 2012; 901: 85-92
        • Dudek A.Z.
        • Raza A.
        • Chi M.
        • et al.
        Brain metastases from renal cell carcinoma in the era of tyrosine kinase inhibitors.
        Clin Genitourin Cancer. 2013; 11: 155-160
        • Sheehan J.P.
        • Sun M.H.
        • Kondziolka D.
        • Flickinger J.
        • Lunsford L.D.
        Radiosurgery in patients with renal cell carcinoma metastasis to the brain: long-term outcomes and prognostic factors influencing survival and local tumor control.
        J Neurosurg. 2003; 98: 342-349
        • Doh L.S.
        • Amato R.J.
        • Paulino A.C.
        • Teh B.S.
        Radiation therapy in the management of brain metastases from renal cell carcinoma.
        Oncology. 2006; 20 (discussion 613, 616, 619-20 passsim): 603-613
        • Du Y.
        • Pahernik S.
        • Hadaschik B.
        • et al.
        Impact of resection and systemic therapy on the survival of patients with brain metastasis of metastatic renal cell carcinoma.
        J Neurooncol. 2016; 130: 221-228
        • Lim S.H.
        • Hwang I.G.
        • Ji J.H.
        • et al.
        Intrinsic resistance to sunitinib in patients with metastatic renal cell carcinoma.
        Asia Pac J Clin Oncol. 2017; 13: 61-67