Background: Incidence of brain metastases is precisely unknown and there is no clear consensus on their management. We aimed to determine the incidence of brain metastases among patients with genito-urinary primaries, present patients’ characteristics and identify prognostic factors. Method: We identified 51 patients treated in Geneva University Hospitals between January 1992 and December 2019. We retrospectively correlated their overall survival with 23 variables. We repeated a multivariate analysis with significant variables. Results: Overall incidence of Brain Metastases (BMs) among Genito-Urinary (GU) patients is estimated to be 1.76% (range per primary GU tumour type: 0.00–6.65%). BMs originate from germ cell tumours in two cases (3.92%), from urothelial cell carcinoma in 15 cases (29.41%), from prostate cancer in 13 cases (25.49%), and from renal cell carcinoma in 21 cases (41.18%); there are no BMs from penile cancer in our cohort. The median age at BM diagnosis is 67 years old (range: 25–92). Most patients (54%) have a stage IV disease at initial diagnosis and 11 patients (22%) have BM at initial diagnosis. Only six patients (12%) are asymptomatic at BM diagnosis. The median Overall Survival (OS) from BM diagnosis is 3 months (range: 0–127). Five patients (10%) are long survivors (OS > 24 months). OS is significantly influenced by patient performance status and administration of systemic treatment. In the absence of meningeal carcinomatosis, OS is influenced by systemic treatment and stereotactic radiosurgery. We also apply the Graded Prognostic Assessment (GPA) score to our cohort and note significant differences between groups. Conclusion: Brain metastases from solid tumours is not a uniform disease, with a prognosis varying a lot among patients. The optimal management for patients with genito-urinary malignancies with brain metastases remain unclear and further research is needed.
背景：脑转移的确切发病率尚不明确，且其治疗策略缺乏明确共识。本研究旨在明确泌尿生殖系统原发肿瘤患者中脑转移的发生率，分析患者临床特征并识别预后影响因素。方法：我们纳入1992年1月至2019年12月期间在日内瓦大学医院接受治疗的51例患者，回顾性分析其总生存期与23项临床变量的相关性，并对显著性变量进行多因素分析。结果：泌尿生殖系统肿瘤患者脑转移总体发生率约为1.76%（不同原发肿瘤类型发生率范围：0.00-6.65%）。脑转移来源包括：生殖细胞肿瘤2例（3.92%）、尿路上皮癌15例（29.41%）、前列腺癌13例（25.49%）及肾细胞癌21例（41.18%）；本队列中未发现阴茎癌来源的脑转移。脑转移确诊中位年龄为67岁（范围：25-92岁）。多数患者（54%）初诊时即为IV期疾病，11例患者（22%）在初诊时即发现脑转移。仅6例患者（12%）在脑转移诊断时无症状。自脑转移诊断起的中位总生存期为3个月（范围：0-127个月），其中5例患者（10%）为长期生存者（总生存期>24个月）。患者体能状态及全身治疗的实施显著影响总生存期。在无脑膜癌病的情况下，全身治疗与立体定向放射外科治疗对总生存期具有影响。本研究同时应用分级预后评估（GPA）评分系统，发现组间存在显著差异。结论：实体瘤脑转移并非均质性疾病，患者预后差异显著。目前针对泌尿生殖系统恶性肿瘤脑转移患者的最佳治疗方案仍不明确，需要进一步深入研究。
肿瘤(癌症)患者之家