Yousef Mahmoud, Hurd Mark W, Yousef Abdelrahman, Ludmir Ethan B, Pillai Ashwathy B, Peterson Jennifer, Koay Eugene J, Albarouki Sali, Tzeng Ching-Wei, Snyder Rebecca, Katz Matthew H G, Wang Huamin, Overman Michael J, Maitra Anirban, Pant Shubham, Smaglo Brandon G, Wolff Robert A, Yao James, Shen John P, Zhao Dan
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Sheikh Ahmed Center for Pancreatic Cancer Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Oncologist. 2025 Jan 17;30(1). doi: 10.1093/oncolo/oyae182.
The prognosis for patients with pancreatic ductal adenocarcinoma (PDAC) is poor. Secondary brain metastasis (Br-M) occurs in less than 1% of patients. Clinical characteristics and molecular alterations have not been characterized in this rare patients' subset.
The Foundry software platform was used to retrospectively query electronic health records for patients with Br-M secondary to PDAC from 2005 to 2023; clinical, molecular, and overall survival (OS) data were analyzed.
Br-M was diagnosed in 44 patients with PDAC. Median follow-up was 78 months; median OS from initial PDAC diagnosis was 47 months. Median duration from PDAC diagnosis to Br-M detection was 24 months; median OS from Br-M diagnosis was 3 months. At Br-M diagnosis, 82% (n = 36) of patients had elevated CA19-9. Lung was the most common preexisting metastatic location (71%) with Br-M, followed by liver (66%). Br-M were most frequently observed in the frontal lobe (34%, n = 15), cerebellar region (23%, n = 10), and leptomeninges (18%, n = 8). KRAS mutations were detected in 94.1% (n = 16) of patients who had molecular data available (n = 17) with KRASG12V being the most frequent subtype 47% (n = 8); KRASG12D in 29% (n = 5); KRASG12R in 18% (n = 3). Patients who underwent Br-M surgical resection (n = 5) had median OS of 8.6 months, while median OS following stereotactic radiosurgery only (n = 11) or whole-brain radiation only (n = 20) was 3.3 and 2.8 months, respectively.
Br-M is a late PDAC complication, resulting in an extremely poor prognosis especially in leptomeningeal disease. KRAS was mutated in 94.1% of the patients and the KRASG12V subtype was prevalent.
胰腺导管腺癌（PDAC）患者的预后较差。继发性脑转移（Br-M）在不到1%的患者中发生。在这一罕见的患者亚组中，临床特征和分子改变尚未得到描述。
使用铸造软件平台回顾性查询2005年至2023年继发于PDAC的Br-M患者的电子健康记录；分析临床、分子和总生存（OS）数据。
44例PDAC患者被诊断为Br-M。中位随访时间为78个月；从最初的PDAC诊断开始的中位OS为47个月。从PDAC诊断到发现Br-M的中位时间为24个月；从Br-M诊断开始的中位OS为3个月。在Br-M诊断时，82%（n = 36）的患者CA19-9升高。肺是Br-M最常见的先前转移部位（71%），其次是肝（66%）。Br-M最常出现在额叶（34%，n = 15）、小脑区域（23%，n = 10）和软脑膜（18%，n = 8）。在有分子数据的患者（n = 17）中，94.1%（n = 16）检测到KRAS突变，其中KRASG12V是最常见的亚型，占47%（n = 8）；KRASG12D占29%（n = 5）；KRASG12R占18%（n = 3）。接受Br-M手术切除的患者（n = 5）的中位OS为8.6个月，而仅接受立体定向放射治疗（n = 11）或仅接受全脑放疗（n = 20）后的中位OS分别为3.3个月和2.8个月。
Br-M是PDAC的晚期并发症，导致预后极差，尤其是在软脑膜疾病中。94.1%的患者KRAS发生突变，KRASG12V亚型最为普遍。
