AUA 2018: Renal Cell Carcinoma and Brain Metastasis: A Seer Analysis

San Francisco, CA (UroToday.com) It known that renal cell carcinoma presents as metastatic disease in up to 25% of new cases. Management decisions are often driven by site and number of metastases along with patient factors. There are some patients that benefit from cytoreductive nephrectomy. However, brain metastases are often viewed as poor prognostic features and often cause patients to be excluded from cytoreductive nephrectomy or participation in clinical trials.  The authors aimed to evaluate patients presenting with brain metastasis and their outcomes utilizing the SEER database. 



For this analysis SEER-18 registries database was queried for all patients with metastatic RCC from 2010-2014. Only patients with renal cancer as their only malignancy were included. Information was available for metastatic disease to bone, liver, lung and brain. Patients were then further stratified into those with isolated brain metastases and those with additional metastasis to other sites as well. Cancer-specific survival was compared between groups.  

A total of 6,667 patients were identified with metastatic RCC. Amongst them, 749 (12.1%) had brain metastasis at time of diagnosis. Of these patients with brain metastasis, 147 (19.9%) had isolated brain metastasis. Patients with brain metastasis were more likely to have additional lung metastasis (p<0.0001) but not liver (p=0.09) or bone (p=0.14) metastasis. Only 8.0% of all patients with brain metastasis underwent cytoreductive nephrectomy, compared to 32.6% of patients with isolated brain metastasis. Patients with isolated brain metastasis treated by cytoreductive nephrectomy had a median survival of 34 months (Figure 1).  

In conclusion, brain metastasis from RCC occurs in about 12% of patients. It appears that many of the patients with isolated brain metastasis can experience durable long-term survival. The authors concluded that this could be beneficial for patient counseling, discussion of cytoreductive nephrectomy, and consideration for inclusion in clinical trials. 

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Presented By: Michael Daugherty, Syracuse, NY, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre  Twitter: @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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