Abstract 5967: Real-world outcomes of renal cell carcinoma and intracranial metastatic disease
Bibliographic record
Abstract
Introduction: Intracranial metastatic disease (IMD) is a serious complication of renal cell carcinoma (RCC). However, large-scale data on its clinical characteristics, survival outcomes, and treatment strategies are limited, especially at the population level. Objective: To examine the clinical features, survival outcomes, and treatment patterns of RCC patients with IMD in Ontario, Canada, and provide insights to optimize patient management. Methods: This population-based retrospective cohort study included RCC patients diagnosed between 2010 and 2019 in Ontario. Demographics, treatments, and survival data were obtained from provincial healthcare records. Kaplan-Meier and Cox regression analyses assessed overall survival (OS). Propensity score matching (PSM) was used to compare survival outcomes between treatment groups. Results: Among 13,353 RCC patients (mean age: 62 years), 4.6% developed IMD (71% metachronous, 29% synchronous), with a median time to IMD of 8.3 months [Interquartile Range: 1.3, 25.6]. Median OS was significantly shorter for patients with IMD (20.9 months) versus those without IMD (125.4 months; p < 0.001). Synchronous IMD (HR: 2.58) was linked to worse OS. Those without metastases at diagnosis had the longest OS (127.0 months), compared to patients with extracranial metastases alone (13.6 months; HR: 6.89) or synchronous IMD (4.8 months; HR: 14.71). Patients with stage 4 disease at diagnosis who developed metachronous IMD had better OS than those who never developed IMD (17.7 vs. 12.0 months). In patients with IMD, systemic therapy was associated with improved survival (HR: 0.47). Stereotactic radiosurgery (SRS) and/or neurosurgery was associated with improved survival, compared to whole-brain radiotherapy (WBRT) or no IMD-directed treatment (HR: 0.47). Propensity-matched analyses showed that receipt of SRS/neurosurgery was associated with improved OS, compared to WBRT or no IMD-directed treatment (25.9 vs. 13.1 months; HR: 0.55). Conclusion: This study provides large-scale, population-based insights into the impact of IMD in RCC. Our findings show that SRS/neurosurgery is protective in all subgroups of RCC patients with IMD, informing clinical decision-making and offering valuable guidance for optimizing patient outcomes and resource allocation. Additionally, these findings highlight the need for routine brain imaging in RCC to enable early detection and improve management strategies. Citation Format: Madison Sherman, Karim Hafazalla, Arjun Sahgal, Georg Bjarnason, Sunit Das. Real-world outcomes of renal cell carcinoma and intracranial metastatic disease [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 5967.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".