Xiao Linlin, Mowery Yvonne M, Czito Brian G, Wu Yajing, Gao Guangbin, Zhai Chang, Wang Jianing, Wang Jun
Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Radiation Oncology, Duke University, Durham, NC, United States.
Front Oncol. 2021 Apr 29;11:652509. doi: 10.3389/fonc.2021.652509. eCollection 2021.
Due to the low incidence of intracranial disease among patients with esophageal cancer (EC), optimal management for these patients has not been established. The aim of this real-world study is to describe the clinical characteristics, treatment approaches, and outcomes for esophageal squamous cell carcinoma (ESCC) patients with brain metastases in order to provide a reference for treatment and associated outcomes of these patients.
Patients with ESCC treated at the Fourth Hospital of Hebei Medical University between January 1, 2009 and May 31,2020 were identified in an institutional tumor registry. Patients with brain metastases were included for further analysis and categorized by treatment received. Survival was evaluated by the Kaplan-Meier method and Cox proportional hazards models.
Among 19,225 patients with ESCC, 66 (0.34%) were diagnosed with brain metastases. Five patients were treated with surgery, 40 patients were treated with radiotherapy, 10 with systemic therapy alone, and 15 with supportive care alone. The median follow-up time was 7.3 months (95% CI 7.4-11.4). At last follow-up, 59 patients are deceased and 7 patients are alive. Median overall survival (OS) from time of brain metastases diagnosis was 7.6 months (95% CI 5.3-9.9) for all cases. For patients who received locoregional treatment, median OS was 10.9 months (95% CI 7.4-14.3), and survival rates at 6 and 12 months were 75.6% and 37.2%, respectively. For patients without locoregional treatment, median OS was 3.0 months (95% CI 2.5-3.5), and survival rates at 6 and 12 months were 32% and 24%, respectively. OS was significantly improved for patients who received locoregional treatment compared to those treated with systematic treatment alone or supportive care (HR: 2.761, 95% CI 1.509-5.053, P=0.001). The median OS of patients with diagnosis-specific graded prognostic assessment (DS-GPA) score 0-2 was 6.4 months, compared to median OS of 12.3 months for patients with DS-GPA >2 (HR: 0.507, 95% CI 0.283-0.911).
Brain metastases are rare in patients with ESCC. DS-GPA score maybe a useful prognostic tool for ESCC patients with brain metastases. Receipt of locoregional treatment including brain surgery and radiotherapy was associated with improved survival.
由于食管癌（EC）患者颅内疾病的发病率较低，尚未确立针对这些患者的最佳管理方案。本项真实世界研究的目的是描述食管鳞状细胞癌（ESCC）脑转移患者的临床特征、治疗方法及预后，以便为这些患者的治疗及相关预后提供参考。
在河北医科大学第四医院机构肿瘤登记处中，确定2009年1月1日至2020年5月31日期间接受治疗的ESCC患者。纳入脑转移患者进行进一步分析，并根据接受的治疗进行分类。采用Kaplan-Meier法和Cox比例风险模型评估生存率。
在19225例ESCC患者中，66例（0.34%）被诊断为脑转移。5例患者接受了手术治疗，40例接受了放射治疗，10例仅接受全身治疗，15例仅接受支持治疗。中位随访时间为7.3个月（95%CI 7.4 - 11.4）。在最后一次随访时，59例患者死亡，7例患者存活。所有病例自脑转移诊断后的中位总生存期（OS）为7.6个月（95%CI 5.3 - 9.9）。对于接受局部区域治疗的患者，中位OS为10.9个月（95%CI 7.4 - 14.3），6个月和12个月的生存率分别为75.6%和37.2%。对于未接受局部区域治疗的患者，中位OS为3.0个月（95%CI 2.5 - 3.5），6个月和12个月的生存率分别为32%和24%。与仅接受全身治疗或支持治疗的患者相比，接受局部区域治疗的患者OS显著改善（HR：2.761，95%CI 1.509 - 5.053，P = 0.001）。诊断特异性分级预后评估（DS-GPA）评分为0 - 2分的患者中位OS为6.4个月，而DS-GPA>2分的患者中位OS为12.3个月（HR：0.507，95%CI 0.283 - 0.911）。
脑转移在ESCC患者中较为罕见。DS-GPA评分可能是ESCC脑转移患者有用的预后工具。接受包括脑手术和放疗在内的局部区域治疗与生存率提高相关。
