Общая выживаемость и факторы прогноза у пациентов с метастазами рака почки в головной мозг после нейрохирургического лечения

Abstract

Treatment of patients with brain metastases is an urgent problem that must be chosen as part of an integrated approach to detection, based on the characteristics of detection, the patient’s condition, and the severity of neurological deficit. The introduction of new techniques used with the use of neurosurgical and drug treatment, the original method of radiation therapy can increase the survival of patients, as well as improve the quality of life. This article presents the results of a retrospective analysis of the overall survival of patients with cerebral metastases of kidney cancer after neurosurgical resection. The aim of the study is to study the overall survival rates in patients with kidney cancer metastases in the brain after neurosurgical treatment. Material and methods. A retrospective analysis of the results of treatment of 114 patients with brain metastases from kidney cancer who received neurosurgical treatment at the National Medical Research Center of Oncology named after N.N. Blokhin. In the overall survival analysis, survival data were found in 102 (89.5%) of 114 patients. Of these, 80 (78.4%) patients died, and 22 (21.5%) patients are still being followed up. The extracranial disease status (ECM) at the time of surgical treatment was known in 82 (71.9%) patients, of which 45 (54.8%) patients underwent ECM, and 37 (45.1%) did not. In 92 (90.1%) patients, total removal of brain metastases (BM) with perifocal and perivascular zones was performed, in the rest of the patients; fragmentary resection of the focus was performed. Results. Overall survival (OS) after neurosurgical treatment 54.4%; 35.6%; 30.8% and 19% at 12, 24, 36, and 60 months, respectively, with a median OS of 13.8 months (95% CI, 10.29 to 18.6). Statistically significant predictors of overall survival were established: Karnofsky index ≥80% (p<0.0001) and absence of extracranial metastases (p=0.0107). The best survival rates were achieved in the group of patients with a history of nephrectomy and targeted or immunotherapy after neurosurgical treatment. Conclusion. Neurosurgical treatment, which is used with microsurgery and intraoperative navigation, allows a rapid reduction in neurological symptoms, good local control in the area of the remote focus with the course of postoperative complications. Neurosurgical intervention includes consideration of overall survival rates and, as part of anticancer drug therapy that increase overall survival rates.