1Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan 2Department of Neurosurgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan 3Department of Radiotherapy, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan 4Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan.
Dis Colon Rectum. 2014 Jan;57(1):56-63. doi: 10.1097/01.dcr.0000436998.30504.98.
Colorectal cancer infrequently causes brain metastasis, and the prognosis is poor.
The aim of this study was to identify the prognostic factors associated with survival and outcome of treatment for patients with brain metastasis from colorectal cancer.
This is a retrospective study from a prospectively collected database.
The investigation took place in a high-volume multidisciplinary tertiary cancer center in Japan.
From 1979 to 2010, 113 consecutive patients who were treated for brain metastasis from colorectal cancer were identified.
The primary outcome measure was overall survival.
Sixty-three patients had neurosurgical resection (including curative resection for 46 patients) followed by whole brain radiotherapy, 9 had stereotactic radiosurgery, 30 had whole brain radiotherapy, and 11 had steroid and palliative care. As a whole, the overall median survival time from diagnosis of brain metastasis was 5.4 months (95% CI, 4.3-7.6 months), and the 1-year survival rate was 29% (95% CI, 22%-38%). In the group of patients who underwent curative neurosurgical resection, the overall median survival time was 15.2 months (95% CI, 9.2-17.8 months), and the 1-year survival rate was 57% (95% CI, 43%-71%). On multivariate analysis, 1 or 2 brain metastatic lesions, no extracranial metastatic lesions, and neurosurgical resection were independent favorable prognostic factors overall (p = 0.0057, 0.0197, and <0.0001), and 1 or 2 brain metastatic lesions, no extracranial metastatic lesion, and no emergence of secondary brain metastatic lesions were independent favorable prognostic factors in the group of patients who underwent curative neurosurgical resection (p = 0.0137, 0.0081, and 0.0010).
This study was limited by its single-institute, retrospective, nonrandomized design and selection bias.
Neurosurgical resection in select patients is a reasonable option for brain metastasis from colorectal cancer, although it is not associated with long-term (5-year) survival. (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A121 ).
结直肠癌很少发生脑转移，预后较差。
本研究旨在确定与结直肠癌脑转移患者生存和治疗结果相关的预后因素。
这是一项从前瞻性收集的数据库中进行的回顾性研究。
研究在日本一家大容量多学科三级癌症中心进行。
1979 年至 2010 年，共确定了 113 例接受结直肠癌脑转移治疗的连续患者。
主要观察指标为总生存。
63 例患者接受了神经外科切除术（包括 46 例根治性切除术），随后行全脑放疗，9 例患者行立体定向放射外科治疗，30 例患者行全脑放疗，11 例患者行类固醇和姑息治疗。总体而言，从脑转移诊断到中位总生存时间为 5.4 个月（95%CI，4.3-7.6 个月），1 年生存率为 29%（95%CI，22%-38%）。在接受根治性神经外科切除术的患者中，中位总生存时间为 15.2 个月（95%CI，9.2-17.8 个月），1 年生存率为 57%（95%CI，43%-71%）。多因素分析显示，1 或 2 个脑转移灶、无颅外转移灶和神经外科切除术是总体上的独立有利预后因素（p = 0.0057、0.0197 和 <0.0001），而在接受根治性神经外科切除术的患者中，1 或 2 个脑转移灶、无颅外转移灶和无继发性脑转移灶是独立有利预后因素（p = 0.0137、0.0081 和 0.0010）。
本研究受到单中心、回顾性、非随机设计和选择偏倚的限制。
在选择的患者中，神经外科切除术是结直肠癌脑转移的合理选择，尽管它与长期（5 年）生存无关。（见视频，补充数字内容 1，http://links.lww.com/DCR/A121）。
