Weinberg Jeffrey S, Suki Dima, Hanbali Fadi, Cohen Zvi R, Lenzi Renato, Sawaya Raymond
Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2003 Nov 1;98(9):1925-33. doi: 10.1002/cncr.11737.
Esophageal carcinoma rarely metastasizes to the brain. The objectives of the current study were to assess the frequency of brain metastasis from an esophageal primary tumor, to determine correlates of survival, and to describe treatment modalities and their outcomes.
Between June, 1993 and July, 2001, 1588 patients with a primary esophageal carcinoma registered at The University of Texas M. D. Anderson Cancer Center; of those, 27 patients (1.7%) had a diagnosis of brain metastasis. The authors collected demographic and clinical data and performed a statistical analysis.
The median age at the time patients were diagnosed with brain metastasis was 62 years. Tumor histologies were adenocarcinoma in 22 patients (82%), unclassified carcinoma in 3 patients (11%), and squamous cell carcinoma in 2 patients (7%). Twenty patients (74%) experienced symptoms related to the brain metastasis. The metastases were treated with whole-brain radiation therapy (WBRT) alone in 15 patients (56%), and 10 patients (37%) underwent surgical resection, 4 of whom (15%) also received WBRT. Two patients (7%) underwent stereotactic radiosurgery. The median survival for the entire cohort after diagnosis of the primary tumor was 12.6 months (95% confidence interval [CI], 2.17-22.5 months), and the median survival after the diagnosis of brain metastasis was 3.8 months (95% CI, 1.1-6.5 months). The longest median survival observed after the diagnosis of brain metastasis (9.6 months) occurred in patients with a single brain lesion who underwent resection and received WBRT. There was a trend toward worse survival in patients with liver metastases and patients in recursive partitioning analysis (RPA) Class II-III versus RPA Class I (P = 0.10 for both; multivariate Cox proportional hazards model analysis).
Approximately 2% of patients with esophageal carcinoma had a diagnosis of brain metastasis. Improved outcome was associated with single brain lesions in patients who underwent surgery and received WBRT. Known liver metastasis and higher RPA scores were associated with a poorer survival trend.
食管癌很少转移至脑。本研究的目的是评估食管原发性肿瘤脑转移的发生率，确定生存相关因素，并描述治疗方式及其结果。
1993年6月至2001年7月期间，1588例原发性食管癌患者在德克萨斯大学MD安德森癌症中心登记；其中，27例（1.7%）被诊断为脑转移。作者收集了人口统计学和临床数据并进行了统计分析。
患者被诊断为脑转移时的中位年龄为62岁。肿瘤组织学类型为腺癌22例（82%），未分类癌3例（11%），鳞状细胞癌2例（7%）。20例（74%）出现与脑转移相关的症状。15例（56%）转移灶仅接受了全脑放疗（WBRT），10例（37%）接受了手术切除，其中4例（15%）还接受了WBRT。2例（7%）接受了立体定向放射外科治疗。原发性肿瘤诊断后整个队列的中位生存期为12.6个月（95%置信区间[CI]，2.17 - 22.5个月），脑转移诊断后的中位生存期为3.8个月（95%CI，1.1 - 6.5个月）。脑转移诊断后观察到的最长中位生存期（9.6个月）出现在接受手术切除并接受WBRT的单发脑转移患者中。肝转移患者以及递归分区分析（RPA）II - III级患者与RPA I级患者相比，生存趋势有变差的趋势（两者P均 = 0.10；多变量Cox比例风险模型分析）。
约2%的食管癌患者被诊断为脑转移。接受手术并接受WBRT的单发脑转移患者预后改善。已知肝转移和较高的RPA评分与较差的生存趋势相关。
