Mongan John P, Fadul Camilo E, Cole Bernard F, Zaki Bassem I, Suriawinata Arief A, Ripple Gregory H, Tosteson Tor D, Pipas J Marc
Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Clin Colorectal Cancer. 2009 Apr;8(2):100-5.
Brain metastases from colorectal cancer (CRC) are uncommon. There has been relatively little published on the host and tumor factors that might lead to this clinical scenario. We reviewed all cases of brain metastases from CRC at Dartmouth-Hitchcock Medical Center over a more than 20-year period to establish incidence and to identify patient and cancer characteristics which were associated with their development.
We present a retrospective review of 39 confirmed cases of brain metastases from CRC diagnosed between 1984 and 2006. Immunohistochemical staining for CXCR4 was performed on all available brain metastasis biopsy specimens.
The incidence of brain metastases from CRC was 2.3%. Left-sided primary colon tumors predominated. The majority of patients had pulmonary metastases at the time brain metastases were identified, and those with preexisting pulmonary metastases had progression of that disease. All patients were symptomatic from brain metastases, and the cerebellum was the most common area of brain involvement. Immunohistochemical analysis confirmed strong expression of CXCR4 in all brain metastases sampled.
The incidence of brain metastases from CRC is low. Primary tumor in the left colon, long-standing pulmonary metastases, especially those with recent progression, and CXCR4 expression by tumor cells are all associated with increased risk of brain metastases. Increased survival among patients with metastatic CRC will likely result in an increased incidence of brain metastases. Further characterization of the role of tumor and host factors might yield better insight into the development, and potentially the prevention, of this devastating situation.
结直肠癌（CRC）脑转移并不常见。关于可能导致这种临床情况的宿主和肿瘤因素的报道相对较少。我们回顾了达特茅斯-希区柯克医疗中心20多年来所有结直肠癌脑转移病例，以确定发病率，并确定与其发生相关的患者和癌症特征。
我们对1984年至2006年间确诊的39例经证实的结直肠癌脑转移病例进行了回顾性研究。对所有可用的脑转移活检标本进行CXCR4免疫组织化学染色。
结直肠癌脑转移的发生率为2.3%。左侧原发性结肠肿瘤占主导。大多数患者在发现脑转移时已有肺转移，且那些已有肺转移的患者出现了该疾病的进展。所有患者均有脑转移症状，小脑是最常受累的脑区。免疫组织化学分析证实，所有采样的脑转移灶中CXCR4均呈强表达。
结直肠癌脑转移的发生率较低。左半结肠癌、长期存在的肺转移，尤其是近期进展的肺转移以及肿瘤细胞CXCR4表达均与脑转移风险增加相关。转移性结直肠癌患者生存率的提高可能会导致脑转移发生率增加。进一步明确肿瘤和宿主因素的作用可能会更好地了解这种灾难性情况的发生，甚至可能预防其发生。
