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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
  • 28 Downloads

Abstract

Purpose

To evaluate the value of nephrectomy for survival prognosis in renal cell carcinoma (RCC) patients with brain metastases (BM).

Methods

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.

Results

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.

Conclusions

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.

Keywords

Brain metastases Renal cell carcinoma Nephrectomy Epidemiology Survival 

Notes

Acknowledgements

The authors would like to thank the SEER program for public access to the database.

Funding

None.

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.

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Copyright information

© 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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