Introduction

The prognosis of renal cell carcinoma (RCC) brain metastasis (BM) is relatively poor. We evaluated the oncological outcomes of synchronous and metachronous BM of metastatic RCC according to local or systemic therapy.

Methods

Metastatic RCC patients (n=93) with synchronous and metachronous BM were retrospectively identified. We analyzed patients and tumor characteristics, treatment method, prognostic factors, BM progression and overall survival (OS). Synchronous BM was compared with metachronous BM using multivariable Cox regression.

Results

76 patients (81.7%) received local therapy (stereotactic radiosurgery [60.0%], radiation therapy [23.5%], neurosurgery [10.1%]) and 54 patients (58.1%) were treated with systemic medical therapy. Median OS after diagnosis of BM were 9.2 months. In multivariable analysis, sarcomatoid component (hazard ratio [HR] 2.807, 95% confidence interval [CI] 1.088-7.239, p=0.0328) and multiple BM (HR 3.177 95% CI 1.561-6.469, p=0.0014) were significant factors for BM progression. MSKCC poor risk (HR 3.672, 95% CI 1.441-9.36, p=0.0064), sarcomatoid component (HR 4.264, 95% CI 2.062-8.820, p=0.0001) and multiple BM (HR 2.838, 95% CI 1.690-4.767, p=0.0001) were prognostic factors for worse OS. In addition, local treatment (HR 0.436, 95% CI 0.237-0.802, p=0.0076) and systemic treatment (HR 0.322, 95% CI 0.190-0.548, p<0.0001) were also independent factors for better OS. Although the OS from initial RCC diagnosis in metachronous BM patients was longer than synchronous BM patients, there was no difference between synchronous and metachronous in BM progression and OS after diagnosis of brain metastasis.

Conclusions

MSKCC poor risk, sarcomatoid component of histology, and multiple BM were poor prognostic factors for OS. Systemic or local treatment improved OS, but the type of synchronous and metachronous BM did not influence BM progression and OS.

Funding

none