Background

Brain metastases (BMs) from colorectal cancer (CRC) are unusual; however, an increase in incidence has been reported. The evidence available on the subject is scarce, and a better understanding is warranted. We aimed to characterize the epidemiology and the outcomes of patients with BMs from CRC.

Patients and Methods

A cohort of patients with BMs from CRC was retrospectively evaluated. Patients were treated in a single center between May 2008 and April 2019. BMs were confirmed by brain computed tomography or magnetic resonance imaging.

Results

A total of 247 consecutive patients were evaluated. Most patients had a left-sided primary tumor (193, 78%) and at least two extra-cranial metastatic sites (194, 78%). Ninety-six patients (39%) were RAS wild-type; 68 patients (27%) were RAS mutated; and 83 patients (34%) were not characterized. Median time from the initial diagnosis to BMs was 27.6 months (interquartile range, 13.1-46.9). Regarding local therapy, 43 patients (17.4%) were treated with BM surgery alone, 76 patients (30.8%) with radiotherapy (RT) alone, and 58 patients (23.5%) with both surgery and RT. Median overall survival (OS) was 2.9 months (95% confidence interval [CI], 2.2-3.5). Six-month and 1-year OS rates were 29% (95% CI, 23-25) and 13.5% (95% CI, 9.2-18.6), respectively. In a multivariable analysis, BM surgery alone (hazard ratio [HR], 0.56; P = .018), RT alone (HR, 0.51; P = .001), and surgery plus RT (HR, 0.27; P < .001) were associated with superior OS, whereas Eastern Cooperative Oncology Group Performance Status 3 or 4 (HR, 2.01; P = .009) and male gender (HR, 1.46; P = .012) were negative prognostic factors. RAS status was not associated with OS.

Conclusion

BMs occur late during the course of colorectal cancer and are more common in patients with a left-sided primary tumor and a high volume of metastatic disease. BMs from colorectal cancer are still associated with an extremely poor prognosis; however, selected patients may benefit from treatment with surgical resection and radiotherapy.

中文翻译：

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结直肠癌脑转移患者的流行病学和结局——这些患者是谁？

背景

结直肠癌 (CRC) 的脑转移 (BM) 不常见；然而，据报道发病率有所增加。关于这个主题的可用证据很少，有必要更好地理解。我们旨在描述 CRC BMs 患者的流行病学和结局。

患者和方法

回顾性评估了一组来自 CRC 的 BMs 患者。2008 年 5 月至 2019 年 4 月期间，患者在一个中心接受治疗。脑部计算机断层扫描或磁共振成像证实了 BM。

结果

共评估了 247 名连续患者。大多数患者有左侧原发性肿瘤 (193, 78%) 和至少两个颅外转移部位 (194, 78%)。 96 名患者 (39%) 为RAS野生型； 68 名患者 (27%) 为RAS突变；83 名患者 (34%) 未进行表征。从最初诊断到 BMs 的中位时间为 27.6 个月（四分位距，13.1-46.9）。在局部治疗方面，43 例（17.4%）患者单独接受 BM 手术，76 例患者（30.8%）单独接受放疗（RT），58 例患者（23.5%）接受手术和 RT。中位总生存期 (OS) 为 2.9 个月（95% 置信区间 [CI]，2.2-3.5）。6 个月和 1 年 OS 率分别为 29% (95% CI, 23-25) 和 13.5% (95% CI, 9.2-18.6)。在一项多变量分析中，单纯 BM 手术（风险比 [HR]，0.56；P  = .018）、单纯放疗（HR，0.51；P  = .001）和手术加放疗（HR，0.27；P< .001) 与优越的 OS 相关，而东部肿瘤协作组表现状态 3 或 4 (HR, 2.01; P  = .009) 和男性 (HR, 1.46; P  = .012) 是负面预后因素。RAS状态与 OS 无关。

结论

BMs 发生在结直肠癌的晚期，并且在左侧原发性肿瘤和大量转移性疾病的患者中更常见。来自结直肠癌的 BMs 仍然与极差的预后相关；然而，选定的患者可能会从手术切除和放射治疗中受益。