clinicaloncologyКлинический случай в онкологииClinical Case in Oncology3034-14773034-4018ОНКОПРАКТИК10.62546/3034-1477-2024-2-4-7-16clinicaloncology-87Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLEАнализ влияния прогностических факторов у больных с метастазами рака почки в головной мозгAnalysis of the influence of prognostic factors in patients with renal cancer metastases to the brainhttps://orcid.org/0000-0002-4335-8446СеменовД. В.SemenovD. V.

Семенов Дмитрий ВладимировичРоссия, 199034, Санкт-Петербург, Университетская наб., 7/9

Dmitry Vladimirovich Semyonov7/9 Universitetskaya Emb., St. Petersburg, 199034, Russia

sema.69@mail.ruhttps://orcid.org/0000-0003-4109-6451ШирокорадВ. И.ShirokoradV. I.

Валерий И. Широкорад143423, Россия, Московская область, пос. Истра, д. 27

Valery I. Shirokorad27 Istra settlement, Moscow region, 143423, Russia

https://orcid.org/0000-0003-4494-1489КострицкийС. В.KostritskyS. V.

Станислав В. Кострицкий143423, Россия, Московская область, пос. Истра, д. 27

Stanislav V. Kostritsky27 Istra settlement, Moscow region, 143423, Russia

ФГБОУ ВО «Санкт-Петербургский государственный университет»; СПб ГБУЗ «Городской клинический онкологический диспансер»РоссияSt. Petersburg State University; St. Petersburg City Clinical Oncology DispensaryRussian FederationГБУЗ города Москвы «Московская городская онкологическая больница № 62»РоссияMoscow City Oncological Hospital No. 62, Moscow State Budgetary Institution of the City of MoscowRussian Federation20242804202524716Copyright © Семенов Д.В., Широкорад В.И., Кострицкий С.В., 20252025Семенов Д.В., Широкорад В.И., Кострицкий С.В.Semenov D.V., Shirokorad V.I., Kostritsky S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.oncocase.ru/jour/article/view/87

Метастазы в головной мозг являются неблагоприятным проявлением почечно-клеточного рака. В настоящее время мы имеем ограниченное представление об опухолевой и иммунной биологии метастазов в головной мозг и факторах резистентности к проведению системной терапии. Оптимальный подход к комплексному лечению метастазов в головной мозг при раке почки остается неясным. Именно поэтому важен поиск дополнительных прогностических факторов у данной категории пациентов.Цель исследования: проанализировать прогностические факторы у больных с метастазами рака почки в головной мозг, влияющие на показатели выживаемости.Материалы и методы. Проведен ретроспективный анализ данных 56 пациентов с метастазами в головной мозг ПКР, получавших лечение в Московской городской онкологической больнице № 62 г. Москвы и Городском клиническом онкологическом диспансере (Санкт-Петербург) с 2006 по 2022 гг., c медианой наблюдения 45,6 мес. В  исследовании преобладали мужчины 48 (85,7%). Солитарные метастазы в  головном мозге выявлены у  19 (33,9%), а более 2 метастазов — у 21 (37,5%) пациента. Промежуточный и неблагоприятный прогноз по IMDC  установлен у  21 (37,5%) и  25 (44,6%) больных соответственно, при этом низкодифференцированные опухоли в первичной опухоли почки выявлены у 28 (50%) пациентов. Лучевая терапия проведена 32 (57,1%), а метастаз - эктомия  — 33 (58,9%) пациентам. В  исследовании изучены клинико-морфологические факторы прогноза, влияющие на показатели выживаемости у больных с метастазами в головной мозг ПКР. Статистический анализ проводился с использованием пакетов программного обеспечения Statistica 10.0 (StatSoft, США) посредством построения кривых Каплана–Мейера и таблиц дожития, построения математической модели дожития.Результаты. 3-летняя и 5-летняя ОВ у больных с метастазами в головной мозг ПКР (n=56) составила 43% и 22% соответственно, при этом медиана ОВ составила 22,3 мес. В однофакторном анализе у больных с метастазами рака почки в головном мозге выявлено, что отрицательное влияние на показатели выживаемости оказывали статус по ECOG (p=0,0047), число метастазов в головном мозге (p<0,001), метастазы в печень (p=0,028), прогноз по IMDC (p=0,024), проведение нефрэктомии (p<0,001) и лучевой терапии (p=0,05). При многофакторном анализе пол (p<0,001), ECOG-статус (p<0,001), степень дифференцировки опухоли (p=0,001), тип и число метастазов в головном мозге (p<0,001), прогноз по IMDC (p<0,001), метастазы в легкие (p<0,001), кости (p<0,001), печень (p=0,001) и лимфатические узлы (p<0,001), а также проведение нефрэктомии (p=0,001) и лучевой терапии (p<0,001) были дополнительными предикторами, влияющими на показатели ОВ у пациентов с метастазами в головном мозге ПКР.Заключение. В нашем исследовании пол, ECOG-статус, степень дифференцировки опухоли, тип и число метастазов в головном мозге, прогноз по IMDC, метастазы в легкие, кости, печень и лимфатические узлы, а также проведение нефрэктомии и лучевой терапии были дополнительными независимыми прогностическими факторами, влияющими на показатели ОВ у пациентов с метастазами в печень ПКР.

Brain metastases are an unfavourable manifestation of renal cell cancer. Currently, we have limited understanding of the tumour and immune biology of brain metastases and resistance factors to systemic therapy. The optimal approach to comprehensive treatment of brain metastases in renal cancer remains unclear. That is why it is important to search for additional prognostic factors in this category of patients.The aim of the study was to analyse prognostic predictors in patients with renal cancer metastases to the brain affecting survival rates.Materials and methods. We retrospectively analysed the data of 56 patients with brain metastases of RCC treated at the Moscow City Oncological Hospital No. 62 in Moscow and the City Clinical Oncological Dispensary (St. Petersburg) from 2006 to 2022, with a median follow-up of 45,6 months. 48 (85,7%) men prevailed in the study. Solitary brain metastases were detected in 19 (33,9%), and more than 2 metastases in 21 (37,5%). Intermediate and poor prognosis according to IMDC was established in 21 (37,5%) and 25 (44,6%), respectively, with low-differentiated tumours in the primary kidney tumour detected in 28 (50%) patients. Radiation therapy was given to 32 (57,1%) and metastasectomy to 33 (58,9%) patients. The study investigated clinical and morphological prognostic factors influencing survival rates in patients with brain metastases of RCC. Statistical analysis was performed using Statistica 10.0 software packages (StatSoft, USA) by constructing Kaplan-Meier curves and survival tables, building a mathematical model of survival.Results. The 3- and 5-year OS in patients with brain metastases of RCC (n=56) was 43% and 22%, respectively, with a median OS of 22,3 months. In single factor analysis in patients with renal cancer brain metastases, ECOG status (p=0,0047), number of brain metastases (p<0,001), liver metastases (p=0,028), IMDC prognosis (p=0,024), nephrectomy (p<0,001) and radiotherapy (p=0,05) were found to have a negative impact on survival rates. In multivariate analysis, gender (p<0,001), ECOG status (p<0,001), degree of tumour differentiation (p=0,001), type and number of brain metastases (p<0,001), IMDC prognosis (p<0,001), metastases to lung (p<0,001), bone (p<0,001), liver (p=0,001) and lymph nodes (p<0,001), as well as nephrectomy (p=0,001) and radiotherapy (p<0,001) were additional predictors affecting AE rates in patients with brain metastases of RCC.Conclusion. In our study, sex, ECOG status, tumour differentiation, type and number of brain metastases, IMDC prognosis, metastases to lung, bone, liver and lymph nodes, as well as nephrectomy and radiotherapy were additional independent prognostic factors affecting OS in patients with brain metastases of RCC. 

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The authors declare that there are no conflicts of interest present.