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Prognostic factors for survival in patients with brain metastases from renal cell carcinoma
Author(s) -
Culine Stéphane,
Bekradda Mohamed,
Kramar Andrew,
Rey Annie,
Escudier Bernard,
Droz JeanPierre
Publication year - 1998
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19981215)83:12<2548::aid-cncr21>3.0.co;2-4
Subject(s) - medicine , renal cell carcinoma , multivariate analysis , univariate analysis , nephrectomy , survival rate , prognostic variable , adverse effect , survival analysis , performance status , surgery , oncology , cancer , kidney
Abstract BACKGROUND Patients presenting with brain metastases from renal cell carcinoma portend a poor prognosis, with a reported median survival of 4‐6 months. Given their short life expectancy, these patients generally have been excluded from clinical trials that assess the efficacy of medical treatments. However, clinical impression suggests that some patients may achieve long term palliation. METHODS The clinical features of 68 patients who were treated at the Institut Gustave Roussy for brain metastases from renal cell carcinoma were collected retrospectively. Using univariate and multivariate analyses, a prognostic model based on independent prognostic factors was established. An external data set of 57 patients was used to validate the model. RESULTS The median survival was 7 months. On univariate analysis survival was related significantly to the following adverse prognostic factors: no initial nephrectomy, left side and temporal location of brain metastases, presence of fever or weight loss, erythrocyte sedimentation rate > 50 mm/h, and time from initial diagnosis to brain metastases ≤ 18 months. Multivariate analyses identified the previous variable as well as the presence of other visceral metastases as independent prognostic factors. Forty‐four patients (65%) with no or 1 adverse prognostic factor (average risk group) had a median survival of 8 months and a 26% 1‐year survival rate. Twenty‐four patients (35%) with 2 adverse prognostic factors (poor risk group) had a median survival of 3 months and a 1‐year survival rate of 9%. This model proved to be discriminant in an external data set; the median survival of patients assigned to the average risk group was 11 months (46% 1‐year survival rate) compared with 4 months (9% 1‐year survival rate) for patients assigned to the poor risk group. CONCLUSIONS Patients presenting with brain metastases from renal cell carcinoma and poor risk prognostic factors are highly unlikely to benefit from medical treatments except symptomatic procedures. Conversely, the enrollment of patients with average risk prognostic factors into clinical trials dealing with chemotherapy or immunotherapy may be considered. Cancer 1998;83:2548‐2553. © 1998 American Cancer Society.