• Yohei Yamamoto, Kyoichi Tomoto, Akihiko Teshigawara, Takuya Ishii, Yuzuru Hasegawa, Yasuharu Akasaki, Yuichi Murayama, and Toshihide Tanaka.
• Department of Neurosurgery, The Jikei University School of Medicine Daisan Hospital Tokyo, Tokyo, Japan; Department of Neurosurgery, The Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan.
• World Neurosurg. 2024 Sep 6.

ObjectiveTo clarify a rational surgical priority, clinical characteristics were compared between brain metastases (BM) from renal cell carcinoma (RCC) and other cancers.MethodsWe reviewed 425 consecutive patients with BM who underwent treatments including surgery between January 2014 and December 2022. Primary cancers included lung (n = 220), breast (n = 46), digestive (n = 65), RCC (n = 25), and others (n = 69). Tumor volume (T), edema volume (E), and edema volume/tumor volume ratio (E/T ratio) were compared between RCC and other primary cancers. Cutoff T values for identifying both symptomatic tumors and tumors suitable for surgery were determined by receiver operating characteristic curves. Factors including E/T ratio, age, Karnofsky Performance Scale score, and tumor characteristics were statistically analyzed.ResultsCutoff values of T and E to determine surgical suitability were 4.973 cm3 (sensitivity, 0.848; specificity, 0.74) and 23.088 cm3 (sensitivity, 0.894; specificity, 0.623), respectively. E/T ratio was significantly higher for RCC than for other cancers (P < 0.01). These results remained consistent after propensity score matching. RCC tended to show a significantly lower frequency of posterior fossa tumor (16%, P < 0.01) and higher rates of single lesions (72%, P = 0.03) and intratumoral hemorrhage (24%, P = 0.02). Subgroup analysis limited to surgical cases showed that E was consistent across tumors, T tended to be smaller, and E/T ratio was significantly higher in RCC.ConclusionsGenerally, symptomatic BM were indicated for surgery. BM from RCC were characteristically single, low-volume lesions with expanding edema and intratumoral hemorrhage, causing symptoms. These results suggest that surgery should be a high priority for BM from RCC.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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