Characteristics and outcomes of patients managed with surgical resection of brain metastasis from renal cell carcinoma.

Abstract

392 Background: For patients with metastatic renal cell carcinoma (mRCC), the presence of brain metastases (BM) confers a poor prognosis compared with alternative metastatic sites. Being an uncommon site of spread, granular data regarding BM in RCC is relatively sparse. We retrospectively reviewed the clinical features and outcomes of patients with surgically-resected BM from mRCC at our institution. Methods: Patients with mRCC and BM were identified within our institutional experience. Clinical and treatment data was obtained from electronic records. A diagnosis of mRCC to the brain was determined by pathological confirmation obtained via metastasectomy or rarely biopsy. Baseline patient demographics, clinicopathological disease characteristics and survival data were extracted. Overall survival (OS) was calculated from the date of BM intervention using Kaplan–Meier methods. Results: 54 patients were identified with surgically resected BM. Median age at RCC diagnosis was 58 years (IQR 49-67) and most patients were male (n = 39, 73%). 30 patients (56%) presented with de novo metastatic disease without any prior localized treatment, and most developed or presented with multiple metastatic sites. The most common histologic subtype was clear cell carcinoma (n = 51, 94%) and high grade disease was common (n = 39, 73%). The initial treatment of BM for the majority of patients was with neurosurgical resection (94%) followed by post-operative stereotactic radiosurgery (SRS) (87%) and systemic therapy (75%). For patients receiving systemic therapy, most received multiple agents (median 2, range 1-5). 32% of patients had received systemic therapy prior to developing BM. 19 patients (35%) received immune-checkpoint inhibitors. The median overall survival for patients from the date of neurosurgical intervention was 14.5 months (95% CI 9.2- 25 months). Conclusions: We present a large institutional series of patients with BM from mRCC treated with surgical resection. While BM remains a poor prognostic factor in mRCC, surgical resection in selected patients remains a viable strategy. Comprehensive molecular profiling of BM and their corresponding primary RCC tumors will shed light on biological tropism of this phenomenon and underscore prognostic and therapeutic implications.[Table: see text]