Quan Ji-Chuan, Guan Xu, Ma Chen-Xi, Liu Zheng, Yang Ming, Zhao Zhi-Xun, Sun Peng, Zhuang Meng, Wang Song, Jiang Zheng, Wang Xi-Shan
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China.
World J Gastrointest Oncol. 2020 Feb 15;12(2):195-204. doi: 10.4251/wjgo.v12.i2.195.
Brain metastasis (BM) from colorectal cancer (CRC) is rarely encountered clinically, and its prognosis has not been fully evaluated.
To construct a scoring system and accurately predict the survival of patients with synchronous BM at diagnosis of CRC.
A retrospective study of 371 patients with synchronous BM from CRC was performed, using the data from 2010 to 2014 from the Surveillance, Epidemiology, and End Results database. Survival time and prognostic factors were statistically analyzed by the Kaplan-Meier method and Cox proportional hazards models, respectively. A scoring system was developed using the independent prognostic factors, and was used to measure the survival difference among different patients.
For the 371 patients, the median overall survival was 5 mo, survival rates were 27% at 1 year and 11.2% at 2 years. Prognostic analysis showed that age, carcinoembryonic antigen level and extracranial metastasis to the liver, lung or bone were independent prognostic factors. A scoring system based on these three prognostic factors classified the patients into three prognostic subgroups (scores of 0-1, 2-3, and 4). The median survival of patients with scores of 0-1, 2-3 and 4 was 14, 5 and 2 mo, respectively ( < 0.001). Subgroup analysis showed that there were significant differences in prognosis among the groups. Score 2-3 0-1: hazard ratio (HR) = 2.050, 95%CI: 1.363-3.083; 0.001; score 4 0-1: HR = 3.721, 95%CI: 2.225-6.225; < 0.001; score 2-3 4: HR = 0.551, 95%CI: 0.374-0.812; = 0.003.
The scoring system effectively distinguishes long-term and short-term survivors with synchronous BM from CRC. These results are helpful in providing a reference for guiding therapy.
结直肠癌（CRC）脑转移（BM）在临床上很少见，其预后尚未得到充分评估。
构建一个评分系统，准确预测CRC诊断时同步性BM患者的生存情况。
对371例CRC同步性BM患者进行回顾性研究，使用2010年至2014年监测、流行病学和最终结果数据库的数据。分别采用Kaplan-Meier法和Cox比例风险模型对生存时间和预后因素进行统计学分析。利用独立预后因素建立评分系统，并用于衡量不同患者之间的生存差异。
371例患者的中位总生存期为5个月，1年生存率为27%，2年生存率为11.2%。预后分析表明，年龄、癌胚抗原水平以及肝、肺或骨的颅外转移是独立的预后因素。基于这三个预后因素的评分系统将患者分为三个预后亚组（评分0 - 1、2 - 3和4）。评分0 - 1、2 - 3和4的患者中位生存期分别为14、5和2个月（<0.001）。亚组分析表明，各组之间预后存在显著差异。评分2 - 3对0 - 1：风险比（HR）=2.050，95%置信区间（CI）：1.363 - 3.083；P<0.001；评分4对0 - 1：HR =3.721，95%CI：2.225 - 6.225；P<0.001；评分2 - 3对4：HR =0.551，95%CI：0.374 - 0.812；P =0.003。
该评分系统有效地区分了CRC同步性BM患者的长期和短期生存者。这些结果有助于为指导治疗提供参考。
