Kothari Nishi, Mellon Eric, Hoffe Sarah E, Frakes Jessica, Shridhar Ravi, Pimiento Jose, Meredith Ken, Tran Nam D, Saeed Nadia, Almhanna Khaldoun
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA ;
Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA ;
J Gastrointest Oncol. 2016 Aug;7(4):562-9. doi: 10.21037/jgo.2016.03.12.
Brain metastases from esophageal carcinoma have historically been rare and associated with poor prognosis. With improvements in systemic disease control, the incidence of brain metastases is expected to rise. To better inform management decisions, we sought to identify factors associated with survival in patients with brain metastasis from esophageal cancer.
We retrospectively identified 49 patients with brain metastasis from stage I-IV primary esophageal cancer treated with surgery, radiation, or a combination of modalities at our tertiary referral center between 1998 and 2015. Medical records were reviewed to collect demographic and clinical information.
Median age at diagnosis of the primary esophageal cancer was 60 years. Forty-one (84%) patients were male and forty patients (82%) had adenocarcinoma. Median overall survival (MS) following esophageal cancer diagnosis was 24 months (range, 3-71 months), and median survival after the identification of brain metastases was 5 months (range, 1-52 months). On univariate analysis, only patients with poor Karnofsky performance status (KPS <70), recursive partitioning analysis (RPA) classification (III), or 3 or more brain metastases were found to have worsened survival after the diagnosis of brain metastases (all P<0.01). Factors not associated with survival were age, gender, histology (adenocarcinoma vs. other), palliative-intent treatment of the primary tumor, time to diagnosis of brain metastases from initial diagnosis, uncontrolled primary tumor at time of brain metastasis diagnosis, or extracranial metastases. On multivariate analysis (MVA, KPS excluded), patients with RPA class I (MS, 14.6 months) or II (MS, 5.0 months) disease had significantly improved overall survival compared to class III disease (MS, 1.6 months, P<0.01). Also on MVA, patients with 1 (MS, 10.7 months) or 2 (MS, 4.7 months) brain metastases had significantly improved overall survival compared to patients with 3 or more brain metastases (MS, 0.3 months, P<0.01). For the 36 patients with 1-2 brain metastases and KPS ≥70, MS was 11.1 months.
While the prognosis for esophageal cancer metastatic to brain remains poor overall, we found that patients with good performance status and limited number of brain lesions have superior survival. Aggressive management may further improve outcomes in these patients.
食管癌脑转移在历史上一直较为罕见，且预后较差。随着全身疾病控制的改善，脑转移的发生率预计将会上升。为了更好地指导治疗决策，我们试图确定食管癌脑转移患者生存的相关因素。
我们回顾性地确定了1998年至2015年间在我们的三级转诊中心接受手术、放疗或联合治疗的49例I-IV期原发性食管癌脑转移患者。查阅病历以收集人口统计学和临床信息。
原发性食管癌诊断时的中位年龄为60岁。41例（84%）患者为男性，40例（82%）患有腺癌。食管癌诊断后的中位总生存期（MS）为24个月（范围3-71个月），脑转移确诊后的中位生存期为5个月（范围1-52个月）。单因素分析显示，只有卡氏功能状态评分（KPS）<70、递归分区分析（RPA）分类为III级或脑转移灶3个及以上的患者在脑转移诊断后生存期缩短（均P<0.01）。与生存无关的因素包括年龄、性别、组织学类型（腺癌与其他）、原发肿瘤的姑息性治疗、从初始诊断到脑转移诊断的时间、脑转移诊断时原发肿瘤未得到控制或存在颅外转移。多因素分析（MVA，排除KPS）显示，RPA I级（MS，14.6个月）或II级（MS，5.0个月）疾病的患者与III级疾病（MS，1.6个月）相比，总生存期显著延长（P<0.01）。同样在MVA中，有1个（MS，10.7个月）或2个（MS，4.7个月）脑转移灶的患者与有3个及以上脑转移灶的患者相比（MS，0.3个月），总生存期显著延长（P<0.01）。对于36例有1-2个脑转移灶且KPS≥70的患者，MS为11.1个月。
虽然食管癌脑转移患者的总体预后仍然较差，但我们发现功能状态良好且脑转移灶数量有限的患者生存期更长。积极的治疗可能会进一步改善这些患者的预后。
