Nozawa Hiroaki, Ishihara Soichiro, Kawai Kazushige, Sasaki Kazuhito, Murono Koji, Otani Kensuke, Nishikawa Takeshi, Tanaka Toshiaki, Kiyomatsu Tomomichi, Hata Keisuke, Watanabe Toshiaki
Department of Surgical Oncology, University of Tokyo, Tokyo, Japan.
Oncology. 2017;93(5):309-314. doi: 10.1159/000478661. Epub 2017 Jul 13.
Difficulties are associated with the management of brain metastasis (BM), which portends a poor prognosis in the treatment of colorectal cancer (CRC). The aim of the present study was to identify risk factors for BM in CRC and evaluate the outcomes of various treatment modalities.
We retrospectively reviewed data on a total of 2,238 patients with primary CRC who underwent surgical resection at our hospital between 1999 and 2014. Predictive factors for BM and prognostic factors after the diagnosis of BM were examined by univariate and multivariate analyses using Cox proportional hazards models.
Three patients (0.1%) had BM at the initial diagnosis, and 23 patients (1.2%) developed metachronous BM during the median follow-up period of 44.6 months. Lung and bone metastases were identified as independent predictive factors for BM. Median survival after the diagnosis of BM was 7.4 months. Stereotactic radiosurgery, administered to 41% of the patients with BM, was associated with a better postdiagnostic survival.
CRC patients with metastasis to the lung or bone were at a higher risk of BM. Because the survival is still limited, it is crucial to determine the treatment strategy in consideration of the characteristics of each therapy and quality of life in CRC patients with BM.
脑转移（BM）的管理存在困难，这预示着结直肠癌（CRC）治疗的预后不良。本研究的目的是确定CRC中BM的危险因素，并评估各种治疗方式的结果。
我们回顾性分析了1999年至2014年间在我院接受手术切除的2238例原发性CRC患者的数据。使用Cox比例风险模型通过单因素和多因素分析来研究BM的预测因素以及BM诊断后的预后因素。
3例患者（0.1%）在初始诊断时即有BM，23例患者（1.2%）在中位随访期44.6个月期间发生异时性BM。肺和骨转移被确定为BM的独立预测因素。BM诊断后的中位生存期为7.4个月。41%的BM患者接受了立体定向放射外科治疗，其诊断后的生存期较好。
发生肺或骨转移的CRC患者发生BM的风险较高。由于生存期仍然有限，考虑到每种治疗的特点和BM的CRC患者的生活质量来确定治疗策略至关重要。
