Division of Oncology, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
Clin Exp Metastasis. 2023 Apr;40(2):177-185. doi: 10.1007/s10585-023-10201-1. Epub 2023 Mar 22.
While colorectal and gastroesophageal cancer represent the two gastrointestinal (GI) tumor entities with the highest incidence of brain metastatic (BM) disease, data on the clinical course of BM patients from hepatopancreatobiliary malignancies are rare. Patients with cholangiocarcinoma (CCA), hepatocellular carcinoma (HCC), pancreatic ductal adenocarcinoma (PDAC) and gastroenteropancreatic neuroendocrine neoplasms (GEP NEN). Treated for BM between 1991 and 2017 at an academic care center were included. Brain metastases-free survival (BMFS) was defined as interval from first diagnosis until BM development. Overall survival (OS) was defined as interval from diagnosis of BM until death or last date of follow-up. Outcome was correlated with clinical and treatment factors. 29 patients from overall 6102 patients (0.6%) included in the Vienna Brain Metastasis Registry presented with BM from hepatopancreatobiliary primaries including 9 (31.0%) with CCA, 10 (34.5%) with HCC, 7 (24.1%) with PDAC and 3 (10.3%) with GEP NEN as primary tumor. Median BMFS was 21, 12, 14 and 7 months and median OS 4, 4, 6 and 4 months, respectively. Karnofsky Performance Status (KPS) below 80% (p = 0.08), age above 60 years (p = 0.10) and leptomeningeal carcinomatosis (LC) (p = 0.09) diagnosed concomitant to solid BM showed an inverse association with median OS (Cox proportional hazards model). In this cohort of patients with BM from hepatopancreatobiliary tumor entities, prognosis was shown to be very limited. Performance status, age and diagnosis of LC were identified as negative prognostic factors.
虽然结直肠癌和胃食管交界癌是脑转移（BM）疾病发病率最高的两种胃肠道（GI）肿瘤实体，但来自肝胆胰恶性肿瘤的 BM 患者的临床病程数据很少。本研究纳入了 1991 年至 2017 年在一家学术治疗中心接受 BM 治疗的胆管癌（CCA）、肝细胞癌（HCC）、胰腺导管腺癌（PDAC）和胃肠胰腺神经内分泌肿瘤（GEP NEN）患者。无 BM 生存（BMFS）定义为从首次诊断到 BM 发展的时间间隔。总生存（OS）定义为从 BM 诊断到死亡或最后随访日期的时间间隔。结果与临床和治疗因素相关。在维也纳脑转移登记处的 6102 名患者中，有 29 名（0.6%）患有来自肝胆胰原发肿瘤的 BM，包括 9 名（31.0%）CCA、10 名（34.5%）HCC、7 名（24.1%）PDAC 和 3 名（10.3%）GEP NEN。中位 BMFS 分别为 21、12、14 和 7 个月，中位 OS 分别为 4、4、6 和 4 个月。Karnofsky 表现状态（KPS）低于 80%（p=0.08）、年龄大于 60 岁（p=0.10）和同时诊断的软脑膜癌病（LC）（p=0.09）与中位 OS 呈负相关（Cox 比例风险模型）。在这组来自肝胆胰肿瘤实体的 BM 患者中，预后非常有限。表现状态、年龄和 LC 的诊断被确定为负预后因素。
