Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
J Gastrointest Surg. 2020 Aug;24(8):1833-1842. doi: 10.1007/s11605-019-04308-8. Epub 2019 Jul 16.
The association of primary tumor location with incidence and prognosis of brain or bone metastasis in metastatic colorectal cancer (mCRC) patients remains unclear. We dissect this association across a large population.
A total of 202,401 CRC patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 were included. For brain metastasis, 9478 cases without brain metastasis information were excluded, leaving 192,923 CRC for incidence analysis and multivariable logistic/Cox regression analyses. Similarly, 193,013 CRC were eligible for bone metastasis analyses.
The incidence of brain or bone metastasis at initial diagnosis was 1.38% and 6.12% in mCRC cohort, respectively. Median survival of CRC patients with brain or bone metastasis was 4 and 5 months, respectively. Primary tumor location is not associated with the incidence of brain metastasis but with bone metastasis. For bone metastasis, right-sided colon cancer (RCC) patients exhibited the lowest incidence, whereas rectal cancer (RC) patients had the highest. For both brain and bone metastases, RCC patients always had the shortest median survival, whereas RC patients had the longest. The common risk factors for brain or bone metastasis were grade III and multi-extracerebral or ectosteal metastases. The favorable prognostic factors for brain or bone metastasis were being female, married, insured, and RC. RCC is an unfavorable prognostic factor.
Primary tumor location impacts incidence proportions of bone metastasis and survival of both brain and bone mCRC patients. Primary tumor location should be taken into consideration in clinical practice and prognostic assessment.
原发肿瘤部位与转移性结直肠癌（mCRC）患者脑转移或骨转移的发生率和预后的关系尚不清楚。我们在一个大人群中剖析了这种关联。
本研究纳入了 2010 年至 2015 年期间来自监测、流行病学和最终结果（SEER）数据库的 202401 例 CRC 患者。对于脑转移，排除了 9478 例没有脑转移信息的病例，剩余 192923 例 CRC 用于发病率分析和多变量逻辑/ Cox 回归分析。同样，有 193013 例 CRC 适合进行骨转移分析。
mCRC 队列中初诊时脑或骨转移的发生率分别为 1.38%和 6.12%。有脑或骨转移的 CRC 患者的中位生存时间分别为 4 个月和 5 个月。原发肿瘤部位与脑转移的发生率无关，但与骨转移的发生率有关。对于骨转移，右半结肠癌（RCC）患者的发生率最低，而直肠癌（RC）患者的发生率最高。对于脑和骨转移，RCC 患者的中位生存时间总是最短，而 RC 患者的中位生存时间最长。脑或骨转移的共同危险因素是肿瘤分级为 III 级和多颅外或骨外转移。脑或骨转移的有利预后因素是女性、已婚、有保险和 RC。RCC 是一个不利的预后因素。
原发肿瘤部位影响骨转移的发生率比例和脑及骨转移 mCRC 患者的生存情况。在临床实践和预后评估中应考虑原发肿瘤部位。
