Alfonzo Horowitz Melanie, Li Marvin, Parker Megan, Arbuiso Alyssa, Gensler Ryan, Sahebjam Solmaz, Redmond Kristin J, Le Dung, Gabre-Kidan Alodia, Azad Nilo, Bettegowda Chetan, Rincon-Torroella Jordina
Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe Street - Phipps 123, Baltimore, MD, 21287-0005, USA.
Department of Medical Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
J Neurooncol. 2025 Jul 21. doi: 10.1007/s11060-025-05107-9.
INTRODUCTION: Colorectal cancer (CRC) is the third most common cancer globally with rising incidence in the young population. While rare, brain metastasis (BM) in CRC patients leads to significant morbidity and mortality. The incidence of BM is expected to rise due to improved screening and treatments extending patient survival. However, limited screening guidelines exist to detect BM in patients with CRC. METHODS: Adult patients with colon and rectum tumors, with and without brain metastases, diagnosed between January 1, 2013, and December 31, 2023, were identified using ICD-10 codes from the TrinetX Oncology database. Statistical analyses were performed on TrinetX. The "incidence and prevalence" function assessed BM prevalence, while the "explore cohorts" function evaluated BM diagnoses over time. The "compare cohorts" function compared patient demographics and oncological characteristics, and the "compare outcomes" function generated Kaplan-Meier survival curves. RESULTS: There were 8,621 patients with CRC diagnosed at Stage IV and 279 (3.4%) developed BM. Patients who develop BM were younger (58.5 ± 12.6 years vs. 62.3 ± 14 years, p < 0.001) and a greater proportion had a KRAS mutation (37.0% vs. 16.0%, p < 0.001) and HER2 amplification (23.0% vs. 12.0%). BM were more common in primary CRC located on the left, specifically in the rectum (41.0%, vs. 36.0%, p < 0.001) or rectosigmoid junction (48.0% vs. 24.0%, p < 0.001). Patients with lung metastasis (OR [95%CI]: 1.67 [1.11-2.57]) or bone (OR [95%CI]: 4.30 [3.05-5.85]) had increased odds of developing BM. Patients with bone metastases developed BM at a median time of less than six months. Stage IV CRC patients who developed BM had decreased overall survival compared to those without BM (liver HR [95%CI]: 1.35 [1.11-1.64]; lung: 1.98 [1.62-2.43]; bone: 1.69 [1.42-2.07]). CONCLUSION: Brain metastasis significantly reduces overall survival in Stage IV CRC patients. Stage IV CRC with pulmonary or osseous metastases have increased risk of BM development. These patients merit increased surveillance to identify BM early and improve survival. Other risk factors include a younger age at diagnosis, left sided primary tumor, KRAS mutation, or HER2 amplification.
引言：结直肠癌（CRC）是全球第三大常见癌症，在年轻人群中的发病率呈上升趋势。虽然罕见，但CRC患者发生脑转移（BM）会导致显著的发病率和死亡率。由于筛查和治疗的改善延长了患者生存期，预计BM的发病率将会上升。然而，目前用于检测CRC患者BM的筛查指南有限。 方法：使用TrinetX肿瘤学数据库中的ICD-10编码，识别出2013年1月1日至2023年12月31日期间诊断为结肠和直肠肿瘤且有或无脑转移的成年患者。在TrinetX上进行统计分析。“发病率和患病率”功能评估BM患病率，而“探索队列”功能评估随时间的BM诊断情况。“比较队列”功能比较患者人口统计学和肿瘤学特征，“比较结果”功能生成Kaplan-Meier生存曲线。 结果：共有8621例CRC患者诊断为IV期，其中279例（3.4%）发生BM。发生BM的患者更年轻（58.5±12.6岁 vs. 62.3±14岁，p< 0.001），且KRAS突变（37.0% vs. 16.0%，p< 0.001）和HER2扩增（23.0% vs. 12.0%）的比例更高。BM在位于左侧的原发性CRC中更常见，特别是在直肠（41.0%，vs. 36.0%，p< 0.001）或直肠乙状结肠交界处（48.0% vs. 24.0%，p< 0.001）。发生肺转移（OR[95%CI]：1.67[1.11 - 2.57]）或骨转移（OR[95%CI]：4.30[3.05 - 5.85]）的患者发生BM的几率增加。发生骨转移的患者发生BM的中位时间不到6个月。与未发生BM的IV期CRC患者相比，发生BM的患者总生存期降低（肝脏HR[95%CI]：1.35[1.11 - 1.64]；肺：1.98[1.62 - 2.43]；骨：1.69[1.42 - 2.07]）。 结论：脑转移显著降低IV期CRC患者的总生存期。伴有肺或骨转移的IV期CRC发生BM的风险增加。这些患者应加强监测以早期发现BM并提高生存率。其他风险因素包括诊断时年龄较小、左侧原发性肿瘤、KRAS突变或HER2扩增。
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