Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Canada.
Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
J Neurooncol. 2024 Mar;167(1):111-122. doi: 10.1007/s11060-024-04576-8. Epub 2024 Feb 19.
Brain metastasis (BrM) and Leptomeningeal Carcinomatosis (LMC) are uncommon complications in gastroesophageal carcinoma (GEC) patients. These patients have a poor prognosis and are challenging to treat. We described the clinicopathologic features and outcomes in the largest cohort of Central Nervous System (CNS) metastasis in GEC patients.
single-center retrospective study of GEC treated from 2007 to 2021. Clinicopathologic characteristics and treatment modalities were reviewed. Survival was calculated from the date of CNS diagnosis until date of death/last follow-up using the Kaplan-Meier method. A multivariable Cox proportional hazards regression model was used.
Of 3283 GEC patients, 100 (3.04%) were diagnosed with BrM and 20 with LMC (0.61%). Patients with known human epidermal growth factor receptor 2 (HER2) status (N = 48), 60% were HER2 positive (defined as IHC 3 + or IHC 2+/FISH+). Among LMC patients most were signet-ring subtype (85%), and only 15% (2/13) were HER2 positive. Median survival was 0.7; 3.8; and 7.7 months in BrM patients treated with best supportive care, radiation, and surgery, respectively (p < 0.001). In LMC, median survival was 0.7 month in patients who had best supportive care (7/19) and 2.8 months for those who had whole brain radiation therapy (p = 0.015). Multivariate analysis showed worse outcomes in ECOG ≥ 2 (p = 0.002), number of BrM ≥ 4 (p < 0.001) and number of metastatic sites (p = 0.009).
HER2 expression were enriched in patients with BrM, while it is uncommon in LMC. Patients treated with surgery followed by radiation had an improved OS in BrM and WBRT benefited patients with LMC.
脑转移（BrM）和脑膜癌病（LMC）是胃食管腺癌（GEC）患者中罕见的并发症。这些患者预后较差，治疗具有挑战性。我们描述了最大的 GEC 患者中枢神经系统（CNS）转移队列的临床病理特征和结局。
这是一项 2007 年至 2021 年间治疗的 GEC 患者的单中心回顾性研究。回顾了临床病理特征和治疗方式。使用 Kaplan-Meier 方法从 CNS 诊断日期到死亡/最后随访日期计算生存时间。使用多变量 Cox 比例风险回归模型。
在 3283 例 GEC 患者中，有 100 例（3.04%）被诊断为 BrM，20 例（0.61%）为 LMC。已知人类表皮生长因子受体 2（HER2）状态的患者（N=48），60%为 HER2 阳性（定义为 IHC 3+或 IHC 2+/FISH+）。在 LMC 患者中，大多数为印戒细胞亚型（85%），仅有 15%（2/13）为 HER2 阳性。接受最佳支持治疗、放疗和手术治疗的 BrM 患者的中位生存期分别为 0.7、3.8 和 7.7 个月（p<0.001）。在 LMC 中，接受最佳支持治疗的患者中位生存期为 0.7 个月（7/19），接受全脑放疗的患者中位生存期为 2.8 个月（p=0.015）。多变量分析显示 ECOG≥2（p=0.002）、BrM≥4（p<0.001）和转移部位数量（p=0.009）与预后较差相关。
HER2 表达在 BrM 患者中丰富，而在 LMC 中则不常见。接受手术联合放疗治疗的 BrM 患者的 OS 得到改善，WBRT 使 LMC 患者受益。
