Touponse Gavin C, Li Guan, Tai Jesse W, Rodrigues Adrian J, Granucci Monica, Burnside Georgiana, Bhambhvani Hriday P, Han Summer S, Ji Hanlee P, Hayden Gephart Melanie
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
World Neurosurg. 2025 Jan;193:964-974. doi: 10.1016/j.wneu.2024.09.085. Epub 2024 Oct 9.
Patients with brain metastases (BrMs) from esophageal cancer have poor prognosis, the incidence of which is expected to rise due to improved survival from the primary tumor and increased neuroimaging. We aimed to identify patient and esophageal cancer characteristics associated with longer survival in patients with BrMs and, secondly, to compare the prognosis of patients with HER2 overexpression.
We retrospectively reviewed patients with BrMs from esophageal cancer at a single institution from 2008-2021. We collected patient demographics, primary tumor and BrM characteristics, and treatment. Our primary outcome was median survival from the time of BrM.
The median age at primary diagnosis was 66.5 years and 86% were male. Of the 49 patients, 71% had adenocarcinoma, 20% squamous cell carcinoma and 8% other. In this group, 71% of patients presented with stage III or IV disease, including 16% with synchronous primary metastatis and BrM. The median time to BrM was 10.1 months (interquartile range 1.7-22.8) and the median survival from BrM was 8.4 months (95% CI 4.8-16.8 months). On multivariable analysis, treatment with stereotactic radiosurgery (hazard ratio [HR] = 0.19; P = 0.04), surgical resection (HR 0.24; P = 0.03), and immunotherapy (HR 0.19; P = 0.04) were associated with increased survival while Karnofsky Performance Status (KPS) ≤70 (HR = 13.2; P < 0.001) was associated with decreased survival. HER2 overexpression was found in 22% of patients, but we noted no survival difference (5.2 months HER2+ vs. 9.8 months HER2neg; P = 0.95).
The median survival from esophageal-to-brain metastasis was 8.4 months. Patients with a single lesion, KPS score >70, and treatment with surgical resection was correlated with improved survival. Further, HER2+ patients had distinct patient and BrM characteristics.
食管癌脑转移（BrM）患者预后较差，由于原发肿瘤生存率提高和神经影像学检查增多，其发病率预计会上升。我们旨在确定与BrM患者较长生存期相关的患者及食管癌特征，其次，比较HER2过表达患者的预后。
我们回顾性分析了2008年至2021年在单一机构就诊的食管癌脑转移患者。我们收集了患者的人口统计学资料、原发肿瘤和BrM特征以及治疗情况。我们的主要结局是从BrM确诊时间起的中位生存期。
初次诊断时的中位年龄为66.5岁，86%为男性。49例患者中，71%为腺癌，20%为鳞状细胞癌，8%为其他类型。在该组中，71%的患者表现为III期或IV期疾病，其中16%为同步原发转移和BrM。发生BrM的中位时间为10.1个月（四分位间距1.7 - 22.8），从BrM确诊起的中位生存期为8.4个月（95%置信区间4.8 - 16.8个月）。多变量分析显示，立体定向放射外科治疗（风险比[HR]=0.19；P = 0.04）、手术切除（HR 0.24；P = 0.03）和免疫治疗（HR 0.19；P = 0.04）与生存期延长相关，而卡诺夫斯基功能状态（KPS）≤70（HR = 13.2；P < 0.001）与生存期缩短相关。22%的患者存在HER2过表达，但我们未发现生存期差异（HER2阳性患者为5.2个月，HER2阴性患者为9.8个月；P = 0.95）。
食管癌脑转移的中位生存期为8.4个月。单发转移灶、KPS评分>70且接受手术切除治疗的患者生存期改善。此外，HER2阳性患者具有独特的患者及BrM特征。
