Abstract：
A diagnosis of brain metastasis (BM) significantly affects quality of life in patients with metastatic renal cell cancer (mRCC). Although systemic treatments have shown efficacy in mRCC, active surveillance (AS) is still commonly used in clinical practice. In this single-center cohort study, we assessed the impact of different initial treatment strategies for metastatic RCC (mRCC) on the development of BM. All consecutive patients diagnosed with mRCC between 2011 and 2022 were included at the Erasmus MC Cancer Institute, the Netherlands, and a subgroup of patients with BM was selected. In total, 381 patients with mRCC (ECM, BM, or both) were identified. Forty-six patients had BM of whom 39 had metachronous BM (diagnosed ≥1 month after ECM). Twenty-five (64.1%) of these 39 patients with metachronous BM had received prior systemic treatment for ECM and 14 (35.9%) patients were treatment naive at BM diagnosis. The median BM-free survival since ECM diagnosis was significantly longer (p = .02) in previously treated patients (29.0 [IQR 12.6-57.0] months) compared to treatment naive patients (6.8 [IQR 1.0-7.0] months). In conclusion, patients with mRCC who received systemic treatment for ECM prior to BM diagnosis had a longer BM-free survival as compared to treatment naïve patients. These results emphasize the need for careful evaluation of treatment strategies, and especially AS, for patients with mRCC.
摘要：
脑转移（BM）的诊断显着影响转移性肾细胞癌（mRCC）患者的生活质量。尽管全身治疗在mRCC中显示出疗效，主动监测（AS）仍然是临床实践中常用的方法。在这项单中心队列研究中，我们评估了转移性肾癌（mRCC）不同初始治疗策略对BM发展的影响。2011年至2022年期间诊断为mRCC的所有连续患者都被包括在伊拉斯谟MC癌症研究所，荷兰,并选择BM患者亚组。总的来说,381例mRCC患者（ECM，BM,或两者)被识别。46例患者患有BM，其中39例患有异时BM（ECM后诊断≥1个月）。在这39例异时性BM患者中，有25例（64.1％）接受了先前的ECM全身治疗，而14例（35.9％）患者在BM诊断时初治。与未接受治疗的患者（6.8[IQR1.0-7.0]个月）相比，先前接受治疗的患者（29.0[IQR12.6-57.0]个月）自ECM诊断以来的中位无BM生存期显着更长（p=.02）。总之,与未接受治疗的患者相比,在BM诊断前接受ECM系统治疗的mRCC患者的无BM生存期更长.这些结果强调需要仔细评估治疗策略，尤其是AS,对于mRCC患者。
