Survival of patients with metastatic renal cell carcinoma with or without brain metastases

Background Historically, brain metastasis (BM) is associated with poor survival for patients with metastatic renal cell carcinoma (mRCC). The prognostic significance of BM in the immune checkpoint (ICI) era is unclear. Methods We performed a retrospective cohort study of patients diagnosed with clear cell RCC (ccRCC) between 2012-2023. We examined the association between BM and overall survival (OS) among patients by treatment type (with or without ICI in any line of therapy) and whether they had brain MRI screening. Results We identified 338 patients with metastatic ccRCC between 2012 and 2023, of whom 96 (28.4%) had BM. mOS from the time of metastatic ccRCC diagnosis was 54.3 months (mo) in patients without BM versus 37.3 mo in patients with BM (p = 0.03). Among patients who received ICI therapy, mOS was 66.4 mo in those without BM versus 37.7 mo in those with BM (p = 0.01). In patients who did not receive ICI therapy, mOS was 32.1 mo in those without BM versus 17.6 mo in those with BM (p = 0.4). In those with BM, mOS from the time of initial metastatic disease diagnosis was 86.7 mo for those who underwent MRI brain screening versus 27.9 mo for those who did not (p = 0.00016). Conclusion In our ccRCC population, OS for patients with metastatic ccRCC and brain metastases has improved in the era of ICI therapy. Brain metastases are associated with poor prognosis. Patients with brain metastases discovered on screening had improved overall survival compared to those with brain metastases discovered because of symptoms.