Kawabata Ryohei, Doki Yuichiro, Ishikawa Osamu, Nakagawa Hidemitsu, Takachi Ko, Miyashiro Isao, Tsukamoto Yoshitane, Ohigashi Hiroaki, Sasaki Yo, Murata Kohei, Ishiguro Shingo, Imaoka Shingi
Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Japan.
Hepatogastroenterology. 2007 Jun;54(76):1043-8.
BACKGROUND/AIMS: Brain metastasis, rarely observed as a tumor recurrence after curative surgery for thoracic esophageal cancers (TEC), has been increasingly observed with improvement of the clinical outcome of TEC.
Records of 254 TEC patients who developed recurrent cancers after curative surgery during 1984-2002 revealed 11 patients (4.3%) with symptomatic brain metastasis, which were classified as five without extra-cranial disease (Brain type) and six with other metastatic diseases (Systemic type).
Brain metastases were significantly associated with an advanced clinical stage and perioperative chemotherapy, which had been undergone by 73% of the brain metastasis patients, but only 23% for non-brain metastasis patients (p = 0.0008). Comparing to Systemic type, Brain type showed longer duration from esophagectomy to brain metastasis and tended to be more effective for perioperative chemotherapy. All Brain type but only two Systemic type brain metastases were removed by surgery. The average survival after brain metastasis was 17.7 months for the Brain type patients (two alive without tumor recurrence), but only 38.5 days for the Systemic type patients. The histological hallmark of Brain type metastasis was medullary tumor growth with mature tumor vessels, while Systemic type showed invasive tumor growth with naive capillaries.
Postoperative brain metastasis in TEC patients is not rare, especially in an advanced clinical stage following perioperative chemotherapy. Surgical removal of brain metastasis might be the most promising treatment unless tumor metastasis in other organs is evident.
背景/目的：脑转移作为胸段食管癌（TEC）根治性手术后的肿瘤复发很少见，但随着TEC临床疗效的提高，其发生率越来越高。
1984 - 2002年期间254例TEC根治性手术后发生复发癌患者的记录显示，11例（4.3%）出现有症状的脑转移，其中5例无颅外疾病（脑型），6例伴有其他转移疾病（全身型）。
脑转移与临床晚期和围手术期化疗显著相关，73%的脑转移患者接受过围手术期化疗，而非脑转移患者仅为23%（p = 0.0008）。与全身型相比，脑型从食管切除到脑转移的时间更长，且围手术期化疗往往更有效。所有脑型脑转移灶但只有2例全身型脑转移灶通过手术切除。脑型患者脑转移后的平均生存期为17.7个月（2例存活无肿瘤复发），而全身型患者仅为38.5天。脑型转移的组织学特征是髓样肿瘤生长伴有成熟的肿瘤血管，而全身型表现为浸润性肿瘤生长伴有幼稚的毛细血管。
TEC患者术后脑转移并不罕见，尤其是在围手术期化疗后的临床晚期。除非其他器官有明显的肿瘤转移，手术切除脑转移灶可能是最有前景的治疗方法。
