Tokoro Tadao, Okuno Kiyotaka, Hida Jin-chi, Ueda Kazuki, Yoshifuji Takehito, Daito Koji, Sugiura Fumiaki
Department of Surgery, Kinki University, Faculty of Medicine, Osaka, Japan.
Department of Surgery, Kinki University, Faculty of Medicine, Osaka, Japan.
Clin Colorectal Cancer. 2014 Dec;13(4):226-31. doi: 10.1016/j.clcc.2014.09.008. Epub 2014 Sep 21.
Increased rates of long-term survival after CRC diagnosis are accompanied by increases in the incidence of BMs. Here, we retrospectively evaluated the outcomes of patients with BMs from CRC.
We reviewed the records of 1364 patients with CRC treated between January 1999 and December 2010 at Kinki University Hospital in Japan. Twenty-five of these patients developed BMs. Log-rank tests and Cox regression analyses were used to assess potential prognostic factors for survival.
Among the patients with BMs, BMs developed a median of 25.3 (range, 11.4-111) months after primary CRC surgery. There was a median of 2 BMs per patient. Eleven patients had solitary BMs. Concomitant extracerebral metastases, particularly lung metastases, were found in 23 patients. Twenty-three patients were receiving systemic chemotherapy at the time of diagnosis with BMs. After the development of BMs, the median survival time (MST) was 2.8 months. The MST was 4.8 months among patients who underwent neurosurgical resection (n = 6) or stereotactic surgery (n = 9, including combined therapy in 2 patients) and 1.5 months among patients who underwent whole-brain radiotherapy only or best supportive care (n = 12). In multivariate analysis, single BMs and additional systemic chemotherapy after BMs diagnosis were significantly associated with overall survival (P = .022 and .023, respectively).
Our results suggest that advancements in continuing systemic chemotherapy prolong survival among patients with BMs from CRC. Clinicians should be especially aware of BMs in patients with lung metastases.
结直肠癌(CRC)诊断后长期生存率的提高伴随着脑转移(BM)发生率的增加。在此,我们回顾性评估了CRC脑转移患者的预后。
我们回顾了1999年1月至2010年12月在日本近畿大学医院接受治疗的1364例CRC患者的记录。其中25例患者发生了脑转移。采用对数秩检验和Cox回归分析来评估生存的潜在预后因素。
在发生脑转移的患者中,脑转移发生在原发性CRC手术后的中位时间为25.3(范围11.4 - 111)个月。每位患者的脑转移灶中位数为2个。11例患者有孤立性脑转移灶。23例患者发现伴有脑外转移,尤其是肺转移。23例患者在诊断为脑转移时正在接受全身化疗。脑转移发生后,中位生存时间(MST)为2.8个月。接受神经外科手术(n = 6)或立体定向手术(n = 9,包括2例联合治疗)的患者的MST为4.8个月,仅接受全脑放疗或最佳支持治疗(n = 12)的患者的MST为1.5个月。在多变量分析中,单个脑转移灶和脑转移诊断后额外的全身化疗与总生存显著相关(分别为P = 0.022和0.023)。
我们的结果表明,持续全身化疗的进展可延长CRC脑转移患者的生存期。临床医生应特别注意有肺转移的患者发生脑转移的情况。