NCTQ-03 Brain Metastases From Renal Cell Carcinoma: A Large Retrospective Claims-Based Oncology Cohort Analysis of Prevalence, Chronicity, and Survival Outcomes

Brain metastases (BM) occur in nearly 10% of patients with advanced renal cell carcinoma (RCC) and portend a poor prognosis. There is a paucity of large population-based or multi-institutional studies characterizing the prevalence and impact of BM on clinical outcomes in patients with RCC. We utilized the TriNetX Oncology database to investigate BM prevalence, BM-free survival, treatment patterns, and outcomes in RCC patients diagnosed between 2014 and 2024. Data from patients with histologically confirmed RCC were extracted from the TriNetX Oncology database. Precocious, synchronous, and metachronous BM were defined as BM diagnosed prior to, within 2 months, and after 2 months of the diagnosis of RCC, respectively. Clinical and demographic variables were compared between patients with and without BM using Chi-squared and t-tests. Kaplan-Meier and Cox regression analyses were used to evaluate overall survival (OS), after propensity score matching cohorts for age at diagnosis, sex, stage at diagnosis, cancer-directed therapy, and extracranial metastases. Among 14,650 patients with RCC, 730 (5.0%) developed BMs (65.8% metachronous, 18.0% synchronous, and 16.2%). Patients with BM had higher rates of extracranial metastases and were more likely to receive radiation (intracranial and/or extracranial) and antineoplastic medications than patients without BM. Patients with BM had lower OS compared to those with extracranial metastases only (HR [95%CI] = 1.38[1.19-1.59]), with median survival of 1.2 years from the diagnosis of BM. From the time of diagnosis of RCC, patients with synchronous BM had poorer OS compared to patients with metachronous BM (HR [95%CI] = 1.95[1.46-2.60]), but there was no significant difference in OS following the diagnosis of BM between these groups (HR [95%CI] = 0.92[0.67-1.27]). Eight percent of patients with BM had non-traumatic intracranial hemorrhage. Here, we demonstrated the increased morbidity and mortality associated with BM in patients with RCC, regardless of their chronicity.