Background

Brain metastases represent a severe complication in many gastrointestinal malignancies especially those arising from the upper gastrointestinal tract, including cancer of the esophagus, gastroesophageal junction, and stomach (GEC). However, there is little knowledge about the onset or potential risk factors for brain metastases (BRMs) in upper gastrointestinal cancers resulting in a lack of screening guidelines for BRMs.

Methods

We analyzed 827 patients from our cancer registry suffering from gastroesophageal cancer (GEC) and treated at the University Medical Center Göttingen between January 2013 and December 2019 for the presence of BRMs.

Results

From 827 patients with GEC we found 54 patients with BRMs, resulting in an incidence of 6.5%. BRMs are more frequent in male patients (90.74% vs 9.26%, p = 0.0051) and in adenocarcinomas (90.74% vs 9.26%, p = 0.0117). Mean duration for the onset of BRMs from initial cancer diagnoses was 20.9 months in limited disease (curative approach) and 9.3 months in advanced disease (palliative approach) (p = 0.0026). However, early detection of BRMs is a prognostic factor since patients with successful resection of BRMs have a better prognosis compared to those with unresectable BRMs (5.93 vs 2.07 months, p = 0.0091).

Conclusion

In this single-center retrospective study, brain metastases (BRMs) occur with a high frequency (6.5%) in gastroesophageal cancer (GEC), significantly more often in male patients and adenocarcinomas. Since survival of these patients considerably correlates with successful BRMs resection, our observations propose further prospective trails to validate our hypothesis and ultimately the implementation of routine screening procedures to detect asymptomatic brain metastases.

中文翻译：

---

胃食管癌的脑转移——一种被低估的并发症

背景

脑转移是许多胃肠道恶性肿瘤的严重并发症，尤其是来自上消化道的恶性肿瘤，包括食道癌、胃食管结合部癌和胃癌 (GEC)。然而，对上消化道癌脑转移（BRM）的发病或潜在危险因素知之甚少，导致缺乏 BRM 筛查指南。

方法

我们分析了 2013 年 1 月至 2019 年 12 月期间在哥廷根大学医学中心接受治疗的 827 名来自我们癌症登记处的胃食管癌 (GEC) 患者是否存在 BRM。

结果

从 827 名 GEC 患者中，我们发现 54 名 BRM 患者，发生率为 6.5%。BRM 在男性患者（90.74% vs 9.26%，p  = 0.0051）和腺癌（90.74% vs 9.26%，p  = 0.0117）中更常见。从初始癌症诊断开始 BRM 发作的平均持续时间在有限疾病（治愈性方法）中为 20.9 个月，在晚期疾病（姑息性方法）中为 9.3 个月（p  = 0.0026）。然而，BRM 的早期发现是一个预后因素，因为与无法切除的 BRM 患者相比，成功切除 BRM 的患者预后更好（5.93 个月 vs 2.07 个月，p  = 0.0091）。

结论

在这项单中心回顾性研究中，脑转移瘤 (BRM) 在胃食管癌 (GEC) 中的发生率很高 (6.5%)，在男性患者和腺癌中更常见。由于这些患者的生存与成功的 BRM 切除有很大关系，我们的观察提出了进一步的前瞻性线索来验证我们的假设，并最终实施常规筛查程序以检测无症状脑转移。