Introduction

Prognosis of patients with brain metastasis (BM) from renal cell carcinoma (RCC) is relevant for treatment decisions and can be estimated with the Renal Graded Prognostic Assessment (GPA). The aim of this study is to validate the updated version of this instrument in a cohort treated with Gamma Knife radiosurgery (GKRS) without prior local intracerebral therapy.

Methods

Between 2007 and 2018, 106 RCC patients with BM were treated with GKRS. They were categorized according to the updated Renal GPA. Overall survival (OS), distant intracranial failure and local failure were estimated using the Kaplan–Meier method and risk factors were identified with Cox proportional hazard regressions.

Results

Median OS was 8.6 months. Median OS for GPA categories 0.0–1.0 (15%), 1.5–2.0 (12%), 2.5–3.0 (35%) and 3.5–4.0 (29%) was 2.9, 5.5, 8.1 and 20.4 months, respectively. Karnofsky performance status < 90, serum hemoglobin ≤ 12.5 g/dL, age > 65 years and time from primary diagnosis to brain metastasis < 1 year were significantly related with shorter survival, while presence of extracranial disease, the volume and total number of BM had no significant impact on OS. A total count of > 4 BM was the only predictive factor for distant intracranial failure, while none of the investigated factors predicted local failure.

Conclusions

This study confirms the updated Renal GPA in an independent cohort as a valuable instrument to estimate survival in patients with BM from RCC treated with GKRS.

中文翻译：

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对接受伽马刀放射外科治疗的肾癌脑转移患者更新的肾脏分级预后评估 (GPA) 的验证

介绍

肾细胞癌 (RCC) 脑转移 (BM) 患者的预后与治疗决策相关，可以使用肾脏分级预后评估 (GPA) 进行估计。本研究的目的是在未经事先局部脑内治疗的情况下接受伽玛刀放射外科 (GKRS) 治疗的队列中验证该仪器的更新版本。

方法

2007 年至 2018 年间，106 名患有 BM 的 RCC 患者接受了 GKRS 治疗。他们根据更新的肾脏 GPA 进行分类。使用 Kaplan-Meier 方法估计总生存期 (OS)、远处颅内衰竭和局部衰竭，并使用 Cox 比例风险回归确定风险因素。

结果

中位 OS 为 8.6 个月。GPA 类别 0.0–1.0 (15%)、1.5–2.0 (12%)、2.5–3.0 (35%) 和 3.5–4.0 (29%) 的中位 OS 分别为 2.9、5.5、8.1 和 20.4 个月。Karnofsky 体力状态 < 90、血清血红蛋白 ≤ 12.5 g/dL、年龄 > 65 岁和从初诊到脑转移的时间 < 1 年与较短的生存期显着相关，而颅外疾病的存在、BM 的体积和总数与对操作系统无显着影响。总计数 > 4 BM 是远处颅内衰竭的唯一预测因素，而所有研究的因素都不能预测局部衰竭。

结论

该研究证实了独立队列中更新的肾脏 GPA 是评估接受 GKRS 治疗的 RCC BM 患者生存率的宝贵工具。