Bone Metastasis in Renal Cell Carcinoma Patients: Risk and Prognostic Factors and Nomograms

Background. Bone metastasis (BM) is one of the common sites of renal cell carcinoma (RCC), and patients with BM have a poorer prognosis. We aimed to develop two nomograms to quantify the risk of BM and predict the prognosis of RCC patients with BM. Methods. We reviewed patients with diagnosed RCC with BM in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Multivariate logistic regression analysis was used to determine independent factors to predict BM in RCC patients. Univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors for BM in RCC patients. Two nomograms were established and evaluated by calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Results. The study included 37,554 patients diagnosed with RCC in the SEER database, 537 of whom were BM patients. BM’s risk factors included sex, tumor size, liver metastasis, lung metastasis, brain metastasis, N stage, T stage, histologic type, and grade in RCC patients. Currently, independent prognostic factors for RCC with BM included grade, histologic type, N stage, surgery, brain metastasis, and lung metastasis. The calibration curve, ROC curve, and DCA showed good performance for diagnostic and prognostic nomograms. Conclusions. Nomograms were established to predict the risk of BM in RCC and the prognosis of RCC with BM, separately. These nomograms strengthen each patient’s prognosis-based decision making, which is critical in improving the prognosis of patients.

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Diagnostic and Prognostic Nomograms for Bone Metastasis in Patients With Newly Diagnosed Renal Cell Carcinoma

10.21203/rs.3.rs-76729/v1 ◽

2020 ◽

Author(s):

Zhangheng Huang ◽

Chuan Hu ◽

Yuexin Tong ◽

Chengliang Zhao

Keyword(s):

Renal Cell Carcinoma ◽

Regression Analysis ◽

Prognostic Factors ◽

Brain Metastasis ◽

Roc Curve ◽

Renal Cell ◽

Histologic Type ◽

Seer Database ◽

Newly Diagnosed ◽

N Stage

Abstract BackgroundBone metastasis (BM) is one of the common sites of renal cell carcinoma (RCC), and patients with BM have a worse prognosis than those without it. We aimed to develop two nomograms to quantify the risk of BM and predict the prognosis of RCC patients with BM.MethodsWe reviewed patients with newly diagnosed RCC with BM in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Multivariate logistic regression analysis was used to determine independent predictors of BM in RCC patients. Univariate and multivariate Cox proportional hazards regression analysis was used to determine independent prognostic factors for BM in RCC patients. Diagnostic and prognostic nomograms were established and evaluated by calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA).ResultsThe study included 37554 patients newly diagnosed with RCC in the SEER database, 537 of whom were BM patients. Risk factors for BM in RCC patients included sex, tumor size, liver metastasis, lung metastasis, brain metastasis, N stage, T stage, histologic type, and grade. Independent prognostic factors for RCC with BM were grade, histologic type, N stage, surgery, brain metastasis, and lung metastasis. Calibration, ROC curve, and DCA showed that both diagnostic and prognostic nomograms showed good performance.ConclusionsDiagnostic and prognostic nomograms were established to predict the risk of BM in RCC and the prognosis of RCC with BM, respectively. These nomograms strengthen each patient's prognosis-based decision making, which is of great significance in improving the prognosis of patients.

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Outcomes and prognostic factors in metastatic renal cell carcinoma patients with brain metastases.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.289 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 289-289

Author(s):

İzzet Dogan ◽

Ayca Iribas ◽

Nail Paksoy ◽

Meltem Ekenel ◽

Sezai Vatansever ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Overall Survival ◽

Prognostic Factors ◽

Brain Metastasis ◽

Brain Metastases ◽

Cell Carcinoma ◽

Renal Cell ◽

De Novo ◽

Brain Radiotherapy ◽

Metastatic Sites

289 Background: The study aimed to evaluate the outcomes and prognostic factors in patients with brain metastatic renal cell carcinoma (bmRCC). Methods: The data of 322 patients with renal cell carcinoma, between 2012 and 2020, were retrospectively reviewed. The clinicopathological features and treatments of the patients with bmRCC were recorded. Overall survival (OS) and prognostic factors were evaluated with Kaplan-Meier analysis and Cox-regression analysis. Results: Forty (12.4%) of the patients had bmRCC. The median follow-up period was 7.3 months (range, 0.2-55.5). The male/female ratio was 2.3, and the median age at diagnosis was 62 years (range, 25-84). Seventeen (42.5%) of the patients were de-novo metastatic, and nine (22.5%) of the patients had brain metastases at presentation. The most common extracranial metastatic sites of the disease were lung (72.5%), bone (47.5%), lymph node (27.5%), and liver (12.5%). Twenty-four (60%) patients previously had received various therapies (tyrosine kinase inhibitor, checkpoint inhibitors, or palliative radiotherapy). After brain metastases developed, 92% of the patients received brain radiotherapy (whole-brain radiotherapy or stereotactic radiosurgery), and twenty-five (62.5%) patients received different therapies. Nine patient received sunitinib, nine patient pazopanib, five patient nivolumab, and two patient axitinib. A total of 32 (80%) patients died during the study period. The median OS was 8.8 months (range, 2.9-14.6) for all patients with bmRCC. Six months- and one-years overall survival ratios were 60% and 40%, respectively. In univariate analysis, the number of brain metastasis (p = 0.352), the localization of brain metastasis (p = 0.790), the longest size of brain metastasis (p = 0.454), the number of extracranial metastatic sites (p = 0.812), de-novo metastatic disease (p = 0.177), primary tumor localization (left or right) (p = 0.903), and tumor grade (p = 0.093) were not statistically significant factors on OS. However, age (p = 0.02), a history of nephrectomy (p < 0.001), receiving brain radiotherapy (p = 0.005), and type of treatment (p = 0.044) was statistically significant. Only, the effect of brain radiotherapy on OS (p = 0.011) was confirmed in multivariate analysis. Conclusions: The prognostic data of patients with bmRCC is limited. In this study, we observed that the prognosis of patients with bmRCC was poor. Despite a small number of patients, we detected that the effect of tyrosine kinase inhibitors and nivolumab was comparable, and receiving brain radiotherapy was a prognostic factor for OS.

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Prognostic Factors for Renal Cell Carcinoma With Bone Metastasis: Who Are the Long-Term Survivors?

The Journal of Urology ◽

10.1016/j.juro.2010.12.037 ◽

2011 ◽

Vol 185 (5) ◽

pp. 1611-1614 ◽

Cited By ~ 25

Author(s):

Haruki Kume ◽

Shigenori Kakutani ◽

Yukio Yamada ◽

Mitsuru Shinohara ◽

Takashi Tominaga ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Prognostic Factors ◽

Bone Metastasis ◽

Cell Carcinoma ◽

Renal Cell ◽

Long Term Survivors

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Prognostic Factors for Survival of Patients With Synchronous or Metachronous Brain Metastasis of Renal Cell Carcinoma

Clinical Genitourinary Cancer ◽

10.1016/j.clgc.2017.05.010 ◽

2017 ◽

Vol 15 (6) ◽

pp. 717-723 ◽

Cited By ~ 20

Author(s):

Se Young Choi ◽

Sangjun Yoo ◽

Dalsan You ◽

In Gab Jeong ◽

Cheryn Song ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Prognostic Factors ◽

Brain Metastasis ◽

Cell Carcinoma ◽

Renal Cell

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The prognosis and clinicopathological features of different distant metastases pattern in renal cell carcinoma: analysis based on SEER database

10.21203/rs.3.rs-191203/v1 ◽

2021 ◽

Author(s):

Haibin Wei ◽

Jia Miao ◽

Jianxin Cui ◽

Wei Zheng ◽

Xinpeng Chen ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cohort Study ◽

Brain Metastasis ◽

Cell Carcinoma ◽

Renal Cell ◽

Cox Regression ◽

Distant Metastases ◽

Clinicopathological Features ◽

Seer Database ◽

Metastatic Sites

Abstract Background: Existing data on the prognosis and clinicopathological features of patients with metastatic renal cell carcinoma (mRCC) are limited. This study aims to investigate the prognostic value and clinicopathological features of different metastatic sites in patients with mRCC. Methods: A dataset from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) 18 Registries (1973–2015) was selected for a retrospective mRCC cohort study. There was information on metastatic sites in lung, bone, liver, and brain. Kaplan-Meier analysis were applied to compare the survival distribution. Univariate and multivariate cox regression models were used to analyze survival outcomes. Results: From the SEER database, a total of 10410 patients with primary mRCC from 2010 to 2015 were enrolled in this cohort study. 54.9%, 37.7%, 19.5%, and 10.4 % of patients were found to have lung, bone, liver, and brain metastasis, respectively. Sarcomatoid RCC had significantly higher risk to develop liver metastasis than clear cell RCC. The median survival for patients with lung, bone, liver, and brain metastasis was 7 months, 7 months, 4 months and 5 months, respectively. Conclusion: In conclusion, different metastatic sites possess various clinicopathological features and prognostic values. Understanding these differences may contribute to designing targeted pre-treatment assessment of primary mRCC and creating a personalized curative intervention.

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Prognostic Factors and Current Treatment Strategies for Renal Cell Carcinoma Metastatic to the Brain: An Overview

Cancers ◽

10.3390/cancers13092114 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2114

Author(s):

Valeria Internò ◽

Pierluigi De Santis ◽

Luigia Stefania Stucci ◽

Roberta Rudà ◽

Marco Tucci ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Clinical Trials ◽

Prognostic Factors ◽

Brain Metastasis ◽

Cell Carcinoma ◽

Stereotactic Radiosurgery ◽

Renal Cell ◽

Checkpoint Inhibitors ◽

Karnofsky Performance Status ◽

The Brain

Renal cell carcinoma (RCC) is one of primary cancers that frequently metastasize to the brain. Brain metastasis derived from RCC has the propensity of intratumoral hemorrhage and relatively massive surrounding edema. Moreover, it confers a grim prognosis in a great percentage of cases with a median overall survical (mOS) around 10 months. The well-recognized prognostic factors for brain metastatic renal cell carcinoma (BMRCC) are Karnofsky Performance Status (KPS), the number of brain metastasis (BM), the presence of a sarcomatoid component and the presence of extracranial metastasis. Therapeutic strategies are multimodal and include surgical resection, radiotherapy, such as stereotactic radiosurgery due to the radioresistance of RCC and systemic strategies with tyrosin kinase inhibitors (TKI) or Immune checkpoint inhibitors (ICI) whose efficacy is not well-established in this setting of patients due to their exclusion from most clinical trials. To date, in case of positive prognostic factors and after performing local radical therapies, such as complete resection of BM or stereotactic radiosurgery (SRS), the outcome of these patients significantly improves, up to 33 months in some patients. As a consequence, tailored clinical trials designed for BMRCC are needed to define the correct treatment strategy even in this poor prognostic subgroup of patients.

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Prognosis of renal cell carcinoma with bone metastases: Experience in 300 consecutive patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.463 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 463-463 ◽

Cited By ~ 2

Author(s):

Fiorella Ruatta ◽

Lisa Derosa ◽

Laurence Albiges ◽

Christophe Massard ◽

Yohann Loriot ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Prognostic Factors ◽

Bone Metastasis ◽

Bone Metastases ◽

Cell Carcinoma ◽

Renal Cell ◽

Poor Prognosis ◽

Radical Resection ◽

Initial Diagnosis ◽

Solitary Bone Metastasis

463 Background: Bone metastases (BMs) are associated with significant morbidity and shorter survival in metastatic renal cell carcinoma (mRCC). Our purpose was to identify prognostic factors for mRCC patients (pts) with BMs. Methods: Data from mRCC pts with BMs, treated at Gustave Roussy between April 1992 and March 2016, were retrospectively collected. Age, sex, ECOG-Performance Status (PS), Memorial Sloan-Kettering Cancer Center (MSKCC) score, histology, number and site of BMs, concomitant metastases (presence and sites), therapy for BMs (radical resection or palliative surgery, radiotherapy, other local and systemic treatments), time to BMs, and outcome were analyzed. Synchronous solitary bone metastasis (SSBM) was defined as a single bone metastasis without concomitant visceral lesions at the initial diagnosis of RCC. Overall survival (OS) was calculated from the date of BMs diagnosis to death or last follow-up using Kaplan-Maier method and modelled with Cox-regression analysis. Results: Three hundred pts were identified. Median time to BMs was 32.4 months (range 0–324 months). In 64 pts (21%), bone was the only metastatic site and 22 of them (7%) had a SSBM; 236 pts (79%) had concomitant metastases in other sites. Median OS was 23.22 months. SSBM pts had better OS then those with concomitant metastases (40 vs. 20 months; p<0.001). At univariate analysis, number of BMs (p<0.0001), spinal column as site of BMs (p<0.005), concomitant metastases (p<0.0001), Fuhrman grade (p<0.001), non-clear cell histology (p<0.003), and MSKCC score (p<0.001) were significantly associated with poor prognosis. At multivariate analysis, concomitant metastases remained predictor of poor prognosis while good MSKCC, radical resection, and SSBM were predictors of better OS. Conclusions: To our knowledge,this is the largest single-institution experience evaluating prognosis in pts with BMs from RCC. This study suggests that MSKCC score, number of BMs (1 vs. >1) and radical resection are prognostic factors. Additionally, in presence of solitary bone metastasis without other concomitant metastases at the initial diagnosis of RCC, bone surgery should be considered to achieve local tumor control and increase survival.

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Analysis of clinical characteristics and prognostic factors of elderly patients with renal cell carcinoma based on SEER database

10.22541/au.162257514.40350691/v1 ◽

2021 ◽

Author(s):

Xiaoyan Peng ◽

Hui Sun ◽

Tianyi Guo ◽

Linxiao Wang ◽

Wanji Guo ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Prognostic Factors ◽

Survival Rate ◽

Clinical Characteristics ◽

Tnm Stage ◽

Seer Database ◽

Chi Square ◽

T Stage ◽

Chi Square Test ◽

N Stage

Background: To study the difference of clinical characteristics and prognostic factors from elderly patients with renal cell carcinoma (RCC), the statistical analysis was carried out based on SEER database. Methods: The relevant clinical informations of 19472 RCC patients from 2010 to 2015 were collected, and the differences of clinicopathological characteristics and survival rate was analyzed by log-rank method and Chi square test, respectively. Multivariate Cox regression model was used to explore the independent risk factors affecting the long-term survival of RCC patients. Results: Chi square test showed a significant correlation between older RCC patients with gender (χ2 = 89.598) , race (χ2 = 129.889), TNM stage (χ2 = 181.709), T stage (χ2 = 145.253), and N stage (χ2 = 81.859). Statistics found that the proportion of 65-69-year age group, male, white population in RCC patients was higher than that of other year groups, female, other race, respectively. The median survival time of 19472 RCC patients was 43 months, and 3-year and 5- year survival rate was 75.95 % and 66.62 %, respectively. Univariate survival analysis showed that the survival time was significant correlation with gender ( χ2 =576.5), TNM stage ( χ2 =8206), T stage ( χ2 =4097), N stage ( χ2 =4849), and M stage ( χ2 =6986). Cox proportional hazards model analysis revealed the independent prognostic factors related with prognosis including TNM stage (HR: 1.527), T stage (HR: 1.044), N stage (HR: 1.334 ), and M stage (HR: 2.686). Conclusion: Age, TNM stage, T stage, N stage, and M stage are independent prognostic factors for RCC patients, which provides an important basis for the clinical analysis of the prognosis of elderly RCC patients in different ages.

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Brain metastasis in metastatic renal cell carcinoma: Predictive factors of occurrence and survival with or without antiangiogenic therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.394 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 394-394

Author(s):

M. Vanhuyse ◽

N. Penel ◽

A. Caty ◽

I. Fumagalli ◽

M. Alt ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Overall Survival ◽

Alkaline Phosphatase ◽

Prognostic Factors ◽

Brain Metastasis ◽

Cell Carcinoma ◽

Renal Cell ◽

Cox Model ◽

Free Survival ◽

Metastatic Rcc

394 Background: We analyzed renal cell carcinoma (RCC) brain metastasis (BM) risk factors and compared BM occurrence in advanced RCC treated with or without antiangiogenic agents (AAA). Methods: Data from all consecutive metastatic RCC patients (pts) treated in the Northern France Cancer Center (Centre Oscar Lambret, Lille) between 1995 and 2008 were reviewed. Eligible pts had histologically confirmed advanced RCC without synchronous BM at the time of metastasis diagnosis. Bellini duct and neuroendocrine carcinoma and sarcoma were excluded. AAA were sorafenib, sunitinib, bevacizumab, temsirolimus, and everolimus. Characteristics of the two groups, treated with or without AAA, were compared with a Fisher exact test. Impact of AAA on overall survival (OS) and BM-free survival (BMFS) was explored by Kaplan-Meier method and adjusted to confounders parameters in a Cox model. Results: A total of 199 pts with advanced RCC were identified, 51 treated with AAA and 148 treated without AAA. The median follow-up duration was 40 months. BM occurred in 35 pts. As expected in this retrospective analysis, characteristics between AAA treated and non AAA treated groups were unbalanced for 11 parameters including age, Motzer prognostic factors, performance status and favoring better prognostic factors in the AAA treated group. The median overall survival was 24 months. Overall survival was higher in patients with AAA versus patients without AAA (31 versus 18 months, hazard ratio (HR) 0.67 [0.45–0.97], p=0.038). The AAA were not associated with better BMFS (HR=0.58 [0.26–1.30], p=0.187). The alkaline phosphatase was an independent prognostic factor for BM (p=0.05). In multivariate cox model, AAA treatment improved the OS (adjusted HR 0.60 [0.38–0.94] but not the BMFS (adjusted HR 0.53 [0.22–1.32]. Conclusions: In this retrospective single center study, elevated alkaline phosphatase is a predictive factor for brain metastasis in metastatic RCC. AAA significantly improved overall survival in advanced RCC without any significant impact on brain-metastasis-free survival. No significant financial relationships to disclose.

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The prognosis and clinicopathological features of different distant metastases patterns in renal cell carcinoma: analysis based on the SEER database

Scientific Reports ◽

10.1038/s41598-021-97365-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Haibin Wei ◽

Jia Miao ◽

Jianxin Cui ◽

Wei Zheng ◽

Xinpeng Chen ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cohort Study ◽

Brain Metastasis ◽

Cell Carcinoma ◽

Renal Cell ◽

Cox Regression ◽

Distant Metastases ◽

Clinicopathological Features ◽

Seer Database ◽

Metastatic Sites

AbstractExisting data on the prognosis and clinicopathological features of patients with metastatic renal cell carcinoma (mRCC) are limited. This study aims to investigate the prognostic value and clinicopathological features of different metastatic sites in patients with mRCC. A dataset from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database consisting of 18 registries (1973–2015) was selected for a retrospective mRCC cohort study. Information was included on the metastatic sites in lung, bone, liver, and brain. Kaplan–Meier analysis was applied to compare the survival distribution. Univariate and multivariate Cox regression models were used to analyze survival outcomes. From the SEER database, a total of 10,410 patients with primary mRCC from 2010 to 2015 were enrolled in this cohort study. Analysis indicated that 54.9%, 37.7%, 19.5%, and 10.4% of patients were found to have lung, bone, liver, and brain metastasis, respectively. There was a significantly higher risk for sarcomatoid RCC patients to develop liver metastasis as compared to patients with clear cell RCC. The median survival for patients with lung, bone, liver, or brain metastasis was 7 months, 7 months, 4 months, and 5 months, respectively. Various clinicopathological features and prognostic values are associated with different metastatic sites. Understanding these differences may enable targeted pre-treatment assessment of primary mRCC and personalized curative intervention for patients.

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