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Quan J, Zuo K, Li G, Liu J, Mei S, Hu G, Qiu W, Zhuang M, Meng L, Wang X, Chang H, Tang J. Prognostic stratification of patients with pT4bN0M0 colorectal cancer following multivisceral resection: a multi-institutional case series analysis. Int J Surg 2024; 110:5323-5333. [PMID: 38768462 PMCID: PMC11392098 DOI: 10.1097/js9.0000000000001646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) patients with stage pT4b are a complex group as they show differences in tumor-infiltrated organs. Patients with the same stage often exhibit differences in prognosis after multivisceral resection (MVR). Thus far, some important prognostic factors have not been thoroughly investigated. Here, we identified the prognostic factors influencing CRC patients at the pT4bN0M0 stage to stratify the prognostic differences among patients. MATERIALS AND METHODS A retrospective analysis was conducted on patients diagnosed with locally advanced CRC and who underwent MVR at three medical institutions from January 2010 to December 2021. The prognostic factors affecting the survival of CRC patients at pT4bN0M0 stage were identified by multivariate Cox proportional hazard models. We then classified the prognosis into different grades on the basis of these independent prognostic factors. RESULTS We enrolled 690 patients with locally advanced CRC who underwent MVR; of these, 172 patients with pT4bN0M0 were finally included. Patients with digestive system [overall survival (OS): hazard ratio (HR)=0.441; 95% confidence interval (CI)=0.217-0.900; P =0.024; disease-free survival (DFS): HR=0.416; 95% CI=0.218-0.796; P =0.008) or genitourinary system invasion (OS: HR=0.405; 95% CI=0.193-0.851; P =0.017; DFS: HR=0.505; 95% CI=0.267-0.954; P =0.035) exhibited significantly better OS and DFS as compared to those with gynecological system invasion, while the OS and DFS were similar between the digestive system and genitourinary system invasion groups (OS: HR=0.941; 95% CI=0.434-2.042; P =0.878; DFS: HR=1.211; 95% CI=0.611-2.403; P =0.583). Multivariate analysis showed that age (OS: HR=2.121; 95% CI=1.157-3.886; P =0.015; DFS: HR=1.869; 95% CI=1.116-3.131; P =0.017) and type of organs invaded by CRC (OS: HR=3.107; 95% CI=1.121-8.609; P =0.029; DFS: HR=2.827; 95% CI=1.142-6.997; P =0.025) were the independent prognostic factors that influenced the OS and DFS of CRC patients with pT4bN0M0 disease. The OS and DFS of patients showing invasion of the gynecological system group were significantly worse ( P =0.004 and P =0.003, respectively) than those of patients with invasion of the nongynecological system group. On the basis of the above-mentioned two independent prognostic factors, patients were assigned to high-risk, medium-risk, and low-risk groups. Subgroup analysis showed that the OS and DFS of the medium-risk and high-risk groups were significantly worse ( P =0.001 and P =0.001, respectively) than those of the low-risk group. CONCLUSION Patients with pT4bN0M0 CRC show significant differences in their prognosis. The type of organs invaded by CRC is a valuable indicator for prognostic stratification of CRC patients with pT4bN0M0.
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Affiliation(s)
- Jichuan Quan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Kai Zuo
- Department of Gastrointestinal Surgery, Linfen People's Hospital, Linfen, Shanxi, People's Republic of China
| | - Guoli Li
- Department of Anorectal Surgery, Chifeng Municipal Hospital, Chifeng
| | - Junguang Liu
- Department of General Surgery, Peking University First Hospital, Beijing
| | - Shiwen Mei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Gang Hu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Wenlong Qiu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Meng Zhuang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Ling Meng
- Department of Gastrointestinal Surgery, Linfen People's Hospital, Linfen, Shanxi, People's Republic of China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Hu Chang
- Department of Hospital Administration Office, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jianqiang Tang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
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Ribeiro LM, Bomtempo FF, Rocha RB, Telles JPM, Neto EB, Figueiredo EG. Development and adaptations of the Graded Prognostic Assessment (GPA) scale: a systematic review. Clin Exp Metastasis 2023; 40:445-463. [PMID: 37819546 DOI: 10.1007/s10585-023-10237-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023]
Abstract
The Graded Prognostic Assessment (GPA) score has the best accuracy among prognostic scales for patients with brain metastases (BM). A wide range of GPA-derived scales have been established to different types of primary tumor BM. However, there is a high variability between them, and their characteristics have not been described altogether yet. We aim to summarize the features of the existent GPA-derived scales and to compare their predictor factors and their uses in clinical setting. Medline was searched from inception until January 2023 to identify studies related to the development, update, or validation of GPA. The initial search yielded 1,083 results. 16 original studies and 16 validation studies were included, comprising a total of 33,348 patients. 13 different scales were assessed, including: GPA, Diagnosis-Specific GPA, Extracranial Score, Lung-molGPA, Updated Renal GPA, Updated Gastrointestinal GPA, Modified Breast GPA, Integrated Melanoma GPA, Melanoma Mol GPA, Sarcoma GPA, Hepatocellular Carcinoma GPA, Colorectal Cancer GPA, and Uterine Cancer GPA. The most prevalent prognostic predictors were age, Karnofsky Performance Status, number of BM, and presence or absence of extracranial metastases. Treatment modalities consisted of whole brain radiation therapy, stereotactic radiosurgery, surgery, cranial radiotherapy, gamma knife radiosurgery, and BRAF inhibitor therapy. Median survival rates with no treatment and with a specific treatment ranged from 6.1 weeks to 33 months and from 3.1 to 21 months, respectively. Original GPA and GPA-derived scales are valid prognostic tools, but with heterogeneous survival results when compared to each other. More studies are needed to improve scientific evidence of these scales.
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Affiliation(s)
| | | | | | | | - Eliseu Becco Neto
- Division of Neurosurgery, University of São Paulo, São Paulo, Brazil
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Wang H, Shan X, Zhang M, Qian K, Shen Z, Zhou W. Nomograms for predicting overall survival in colorectal cancer patients with metastasis to the liver, lung, bone, and brain. Cancer Causes Control 2023; 34:1059-1072. [PMID: 37486401 DOI: 10.1007/s10552-023-01744-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The aim of this study was to identify the heterogeneous and homogeneous prognostic factors associated with distant metastasis to the liver, lung, bone, and brain in colorectal cancer (CRC) patients and then construct nomograms to predict the prognosis. METHODS CRC patients registered in the surveillance, epidemiology, and end results database between 2010 and 2017 were included. A Cox regression model was used to analyse homogeneous and heterogeneous prognostic factors, and Kaplan‒Meier analysis was performed to estimate overall survival (OS). Predictive nomograms were constructed, and their performance was evaluated with C-indexes, calibration curves and the area under the receiver operating characteristic (ROC) curve (AUC). RESULTS A total of 37,641 patients with distant metastasis to the liver, lung, bone, and brain were included. The median survival times of patients with liver metastasis, lung metastasis, bone metastasis, and brain metastasis were 12.00 months (95% CI 11.73-12.27 months), 10.00 months (95% CI 9.60-10.41 months), 5.00 months (95% CI 4.52-5.48 months), and 3.00 months (95% CI 2.28-3.72 months), respectively. An older age, higher N stage, elevated carcinoembryonic antigen level, no surgery at the primary site and no/unknown treatment with chemotherapy were identified as homogeneous prognostic factors for the four types of metastases. The calibration curves, C-indexes and AUCs exhibited good performance for predicting the OS of patients with distant metastases to the liver, lung, bone, and brain. CONCLUSIONS CRC patients with distant metastasis to the liver, lung, bone, and brain exhibited homogeneous and heterogeneous prognostic factors, all of which were associated with shorter survival. The nomograms showed good accuracy and may be used as tools for clinicians to predict the prognosis of CRC patients with distant metastasis.
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Affiliation(s)
- Hongmei Wang
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Department of Pharmacology, College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China
- Chongqing Key Laboratory of Drug Metabolism, Chongqing Medical University, Chongqing, 400016, China
- Key Laboratory for Biochemistry and Molecular Pharmacology of Chongqing, Chongqing Medical University, Chongqing, 400016, China
| | - Xuefeng Shan
- Department of Pharmacy, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China
| | - Min Zhang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China
| | - Kun Qian
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhengze Shen
- Department of pharmacy, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China.
| | - Weiying Zhou
- Department of Pharmacology, College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China.
- Chongqing Key Laboratory of Drug Metabolism, Chongqing Medical University, Chongqing, 400016, China.
- Key Laboratory for Biochemistry and Molecular Pharmacology of Chongqing, Chongqing Medical University, Chongqing, 400016, China.
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Li Y, Wu J, Liu F, Shao X, Liang X, Zhang F, Meng Y, Shen M, Pan M. Single-fraction SRS and multiple-fraction SRT for brain metastases from colorectal cancer. Front Oncol 2022; 12:1060570. [PMID: 36561523 PMCID: PMC9765633 DOI: 10.3389/fonc.2022.1060570] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Brain metastasis from colorectal cancer (CRC) is rare. Although stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) are effective treatments for brain metastasis, reports on brain metastasis of CRC are limited. This study compared the efficacy of SRT and SRS for the treatment of brain metastases from CRC and analysed the related factors to reveal the specificity CRC-derived brain metastasis. Methods A retrospective analysis of 116 patients with brain metastases from colorectal cancer was performed and included 56 patients in the SRT group and 60 patients in the SRS group. The clinical characteristics of the two groups were analysed, and the local tumour control rate, overall survival time and radiation-induced brain injury were compared between the two groups. Results The objective response rates of the SRT and SRS groups were 76.8% and 66.7%, respectively, while the local control rates at 6 months were 87.5% and 81.6%, respectively, and no significant differences were observed between the groups (P=0.295). The median overall survival time was 10.3 months for all patients and was 10.9 months in the SRT group and 9.8 months in the SRS group, with no significant difference between the groups (P=0.123). A multivariate analysis showed that the main factors of poor prognosis were low GPA score (P=0.002), KRAS mutation (P=0.035), extracranial metastasis (P=0.005) and no bevacizumab treatment (P=0.001). No significant difference was observed in the incidence of acute and late radiation-induced injury between the two groups. Conclusion Both SRT and SRS are effective methods for the treatment of CRC-derived brain metastases. The simultaneous use of bevacizumab may be one of the most important factors that affects the survival of these patients.
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Affiliation(s)
- Yong Li
- Department of Radiation Oncology, Third Affiliated Hospital of Naval Medical University, Shanghai, China,Center of Radiation Oncology, Chinese People's Armed Police Force Shanghai Corps Hospital, Shanghai, China
| | - Junlan Wu
- Center of Radiation Oncology, Chinese People's Armed Police Force Shanghai Corps Hospital, Shanghai, China
| | - Fenghua Liu
- Department of Radiation Oncology, Third Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xianjun Shao
- Center of Radiation Oncology, Chinese People's Armed Police Force Shanghai Corps Hospital, Shanghai, China
| | - Xiaohua Liang
- Department of Oncology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Feifei Zhang
- Center of Radiation Oncology, Chinese People's Armed Police Force Shanghai Corps Hospital, Shanghai, China
| | - Yan Meng
- Department of Radiation Oncology, Third Affiliated Hospital of Naval Medical University, Shanghai, China,*Correspondence: Yan Meng, ; Meihua Shen, ; Mianshun Pan,
| | - Meihua Shen
- Center of Radiation Oncology, Chinese People's Armed Police Force Shanghai Corps Hospital, Shanghai, China,*Correspondence: Yan Meng, ; Meihua Shen, ; Mianshun Pan,
| | - Mianshun Pan
- Center of Radiation Oncology, Chinese People's Armed Police Force Shanghai Corps Hospital, Shanghai, China,*Correspondence: Yan Meng, ; Meihua Shen, ; Mianshun Pan,
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Li W, Wang T, Zhu Y, Yu H, Ma L, Ding Y, Hong G, Lei D. Brain metastasis from colorectal cancer: Treatment, survival, and prognosis. Medicine (Baltimore) 2022; 101:e30273. [PMID: 36221357 PMCID: PMC9542566 DOI: 10.1097/md.0000000000030273] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
To investigate the clinical characteristics, survival, prognostic factors, and treatment of brain metastasis (BM) from colorectal cancer (CRC). Twenty-one patients with BM from CRC were retrospectively reviewed. Predictive factors for BM and prognostic factors after the diagnosis of BM were examined by univariate and multivariate COX analysis. The time from the development of extracranial metastases, including lung, bone, and liver, to the occurrence of BM was recorded separately. The median overall survival time was 7 months. In univariate prognostic analysis, median survival with multimodal therapy was better than that with unimodal therapy (10 months vs 3 months, P = .000). In addition, median survival with Karnofsky performance status (KPS) < 70, 1 BM lesion, primary tumor stage of II-III, extracranial lesions < 2, and no extracranial metastasis were much better than the other groups (P < .05 of all). Although there was not a significant difference in median survival between patients receiving combination treatment with bevacizumab and those who did not, treatment with bevacizumab was associated with better survival (10 months vs 5 months, P = .436). The time intervals from bone, liver, and lung metastases to BM were 3, 6.5, and 11 months, respectively. Based on multivariate Cox analysis, KPS and treatment modalities were independent prognosis factors (P = .039 and P = .000, respectively). CRC patients with a high KPS and multimodal treatment have improved survival.
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Affiliation(s)
- Wenxia Li
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Tongsheng Wang
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Yubing Zhu
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Haijiao Yu
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Ling Ma
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Yuhan Ding
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Gao Hong
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Ding Lei
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
- *Correspondence: Lei Ding, Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, No. 10 Tieyi Road, Beijing 100038, China (e-mail: )
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Müller S, Köhler F, Hendricks A, Kastner C, Börner K, Diers J, Lock JF, Petritsch B, Germer CT, Wiegering A. Brain Metastases from Colorectal Cancer: A Systematic Review of the Literature and Meta-Analysis to Establish a Guideline for Daily Treatment. Cancers (Basel) 2021; 13:900. [PMID: 33669974 PMCID: PMC7924831 DOI: 10.3390/cancers13040900] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 02/01/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common malignancy worldwide. Most patients with metastatic CRC develop liver or lung metastases, while a minority suffer from brain metastases. There is little information available regarding the presentation, treatment, and overall survival of brain metastases (BM) from CRC. This systematic review and meta-analysis includes data collected from three major databases (PubMed, Cochrane, and Embase) based on the key words "brain", "metastas*", "tumor", "colorectal", "cancer", and "malignancy". In total, 1318 articles were identified in the search and 86 studies matched the inclusion criteria. The incidence of BM varied between 0.1% and 11.5%. Most patients developed metastases at other sites prior to developing BM. Lung metastases and KRAS mutations were described as risk factors for additional BM. Patients with BM suffered from various symptoms, but up to 96.8% of BM patients were asymptomatic at the time of BM diagnosis. Median survival time ranged from 2 to 9.6 months, and overall survival (OS) increased up to 41.1 months in patients on a multimodal therapy regimen. Several factors including age, blood levels of carcinoembryonic antigen (CEA), multiple metastases sites, number of brain lesions, and presence of the KRAS mutation were predictors of OS. For BM diagnosis, MRI was considered to be state of the art. Treatment consisted of a combination of surgery, radiation, or systemic treatment.
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Affiliation(s)
- Sophie Müller
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Franziska Köhler
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Anne Hendricks
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Carolin Kastner
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Kevin Börner
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Johannes Diers
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Johan F. Lock
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Bernhard Petritsch
- Department of Radiology, University Hospital Wuerzburg, 97084 Wuerzburg, Germany;
| | - Christoph-Thomas Germer
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg, 97084 Wuerzburg, Germany
| | - Armin Wiegering
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg, 97084 Wuerzburg, Germany
- Theodor Boveri Institute, Biocenter, University of Wuerzburg, 97084 Wuerzburg, Germany
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Liu AK, Wu J, Berthelet E, Lalani N, Chau N, Tran E, Hamilton SN. Clinical features of head and neck cancer patients with brain metastases: A retrospective study of 88 cases. Oral Oncol 2020; 112:105086. [PMID: 33186892 DOI: 10.1016/j.oraloncology.2020.105086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/07/2020] [Accepted: 10/27/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Brain metastases (BM) arising from head and neck cancer (HNC) are rare and not well characterized. This study aims to describe the clinicopathological features, treatments, prognostic factors, and survival in HNC patients with BM. MATERIALS AND METHODS Non-thyroid HNC patients referred to BC Cancer from 1998 to 2016 were retrospectively reviewed for BM. The Kaplan-Meier method, log-rank test, and Cox regression analysis were used to assess post-BM survival and prognostic factors. RESULTS Out of 9432 HNC patients, 88 patients developed BM (0.9%, median follow-up 3.4 years). On average, the BM were diagnosed 18.5 months after the primary diagnosis and tended to arise after distant metastases to extracranial sites (85%) such as the lungs (78%). At BM presentation, 84% were symptomatic and two thirds had a poor performance status (ECOG ≥ 2, 68%). The median post-BM survival was 2.5 months (95% CI 2.1-3.3 months). On multivariable analysis, management of BM with radiotherapy (RT) alone (3.3 months, 95% CI 2.3-4.6, p = 0.005) and RT with surgery (4.4 months, 95% CI 2.8-6.9, p < 0.001) was associated with longer survival compared to best supportive care alone (1.4 months, 95% CI 1.0-2.0 months). Age, sex, performance status, sub-localization of the primary HNC, presence of extracranial metastases, and number of intracranial metastases were not associated with post-BM survival (all p ≥ 0.05). CONCLUSION This is the largest study to date in BM from HNC. BM occur late in the course of HNC and carry a poor prognosis. Treatment with intracranial radiotherapy both with and without surgery was associated with improved survival.
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Affiliation(s)
- Alvin K Liu
- University of British Columbia, Faculty of Medicine, 317 - 2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Jonn Wu
- University of British Columbia, Department of Surgery, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada; BC Cancer Vancouver, Department of Radiation Oncology, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada
| | - Eric Berthelet
- University of British Columbia, Department of Surgery, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada; BC Cancer Vancouver, Department of Radiation Oncology, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada
| | - Nafisha Lalani
- University of British Columbia, Department of Surgery, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada; BC Cancer Vancouver, Department of Radiation Oncology, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada
| | - Nicole Chau
- University of British Columbia, Faculty of Medicine, 317 - 2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada; BC Cancer Vancouver, Department of Medical Oncology, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada
| | - Eric Tran
- University of British Columbia, Department of Surgery, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada; BC Cancer Vancouver, Department of Radiation Oncology, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada
| | - Sarah Nicole Hamilton
- University of British Columbia, Department of Surgery, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada; BC Cancer Vancouver, Department of Radiation Oncology, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada.
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Prognostic factors for survival in colorectal cancer patients with brain metastases undergoing whole brain radiotherapy: multicenter retrospective study. Sci Rep 2020; 10:4340. [PMID: 32152433 PMCID: PMC7062910 DOI: 10.1038/s41598-020-61354-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/24/2020] [Indexed: 11/12/2022] Open
Abstract
Whole brain radiotherapy (WBRT) is a mainstay of the treatment for brain metastases (BM). We evaluated prognostic factors in colorectal cancer (CRC) patients undergoing WBRT for BM. The medical records of 106 CRC patients undergoing WBRT for BM between 2000 and 2014 at three institutions were reviewed. Patient and tumor factors were analyzed to identify the prognostic factors for overall survival (OS) calculated from the date of BM diagnosis to the date of death or last follow-up. Surgical resection of BM was performed in six patients. The dose of WBRT was 30 Gy, and boost radiotherapy or stereotactic radiosurgery (8–23 Gy) was given to 15 patients. Systemic therapy for BM was administered in one patient before WBRT and 26 patients after WBRT. The median follow-up time was 3.9 months (range, 0.4–114.1 months). The median OS time was 3.9 months, and the 1-year OS rate was 18.2%. Older age (>65 years), multiple BM (≥3), elevated level of carcinoembryonic antigen (CEA, >5 ng/ml) at BM diagnosis, and extracranial metastases were adverse prognostic factors for OS. Patient with 0–1 factor showed better OS (at 1 year, 76.9%) than patients with 2 factors (16.7%) or 3–4 factors (4.2%; p < 0.001). In conclusion, we evaluated age, the number of BM, CEA level, and extracranial metastases as the prognostic factors for OS in CRC patients undergoing WBRT. Our result might be useful to develop prognostic models predicting survival for patients whom WBRT is intended for.
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Quan JC, Guan X, Ma CX, Liu Z, Yang M, Zhao ZX, Sun P, Zhuang M, Wang S, Jiang Z, Wang XS. Prognostic scoring system for synchronous brain metastasis at diagnosis of colorectal cancer: A population-based study. World J Gastrointest Oncol 2020; 12:195-204. [PMID: 32104550 PMCID: PMC7031150 DOI: 10.4251/wjgo.v12.i2.195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/14/2019] [Accepted: 11/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Brain metastasis (BM) from colorectal cancer (CRC) is rarely encountered clinically, and its prognosis has not been fully evaluated.
AIM To construct a scoring system and accurately predict the survival of patients with synchronous BM at diagnosis of CRC.
METHODS A retrospective study of 371 patients with synchronous BM from CRC was performed, using the data from 2010 to 2014 from the Surveillance, Epidemiology, and End Results database. Survival time and prognostic factors were statistically analyzed by the Kaplan-Meier method and Cox proportional hazards models, respectively. A scoring system was developed using the independent prognostic factors, and was used to measure the survival difference among different patients.
RESULTS For the 371 patients, the median overall survival was 5 mo, survival rates were 27% at 1 year and 11.2% at 2 years. Prognostic analysis showed that age, carcinoembryonic antigen level and extracranial metastasis to the liver, lung or bone were independent prognostic factors. A scoring system based on these three prognostic factors classified the patients into three prognostic subgroups (scores of 0-1, 2-3, and 4). The median survival of patients with scores of 0-1, 2-3 and 4 was 14, 5 and 2 mo, respectively (P < 0.001). Subgroup analysis showed that there were significant differences in prognosis among the groups. Score 2-3 vs 0-1: hazard ratio (HR) = 2.050, 95%CI: 1.363-3.083; P = 0.001; score 4 vs 0-1: HR = 3.721, 95%CI: 2.225-6.225; P < 0.001; score 2-3 vs 4: HR = 0.551, 95%CI: 0.374-0.812; P = 0.003.
CONCLUSION The scoring system effectively distinguishes long-term and short-term survivors with synchronous BM from CRC. These results are helpful in providing a reference for guiding therapy.
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Affiliation(s)
- Ji-Chuan Quan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xu Guan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Chen-Xi Ma
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ming Yang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhi-Xun Zhao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Peng Sun
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
| | - Meng Zhuang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Song Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
| | - Zheng Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xi-Shan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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