Brain metastases in colorectal cancer: prognostic factors and survival analysis

Huerta, L. Del Carpio; Manrique, A.C. Virgili; Szafranska, Justyna; Martı́n-Richard, Marta; López-Bravo, D. Páez; García, A. Sebio; Mariscal, Iñigo Espinosa; Pons, Paula Gomila; Granyò, M. Andrés; Joaquín, A. Barba; Molins, A. Barnadas; Puyal, María Tobeña

doi:10.1007/s00384-018-3107-6

Cited by 12 publications

(11 citation statements)

References 31 publications

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“…Previous studies have reported controversial results on surgery combined with radiotherapy for CRC patients with BM. 11 Some surgeons recommend surgery combined with radiotherapy as it improves CRC patient survival better than surgery only, and others found no differences between the two treatments. 12–14 Prospective studies including more samples should be carried out to assess treatments’ effectiveness and explore effective prognostic factors for CRC patients with BM.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported controversial results on surgery combined with radiotherapy for CRC patients with BM. 11 Some surgeons recommend surgery combined with radiotherapy as it improves CRC patient survival better than surgery only, and others found no differences between the two treatments. [12][13][14] Prospective studies including more samples should be carried out to assess Previous studies have explored factors associated with prognosis of CRC patients with BM, including extracranial metastases, number of BMs, and treatment of BM; 6,7,15,16 However, conclusions were varied among different studies.…”

Section: Discussionmentioning

confidence: 99%

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Factors Prognostic for Brain Metastases from Colorectal Cancer: A Single-Center Experience in China

Wang

Chen

et al. 2021

CMAR

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Purpose This study aimed to analyze clinicopathological, survival, prognostic factors, as well as the timing of brain metastases (BM) in colorectal cancer (CRC) using data from a Chinese center. Patients and Methods Data of 65 consecutive CRC patients with BM were collected from a single institution in China. The time from primary tumor surgery to the occurrence of BM was calculated. Kaplan-Meier analysis was used to evaluate cumulative survival of patients. Factors associated with prognosis of overall survival (OS) were explored using Cox’s proportional hazard regression models. Results The median time interval from CRC surgery to the diagnosis of BM was 24 months. After diagnosis of BM, median OS values for patients were 11 months. Extracranial metastases occurred in 45 cases (69.2%) when BM was diagnosed, and 58.5% of these patients with lung metastases Time of BMs ( P =0.018), presence of extracranial metastases ( P =0.033), treatment ( P =0.003), CA199 ( P =0.034), CA125 ( P <0.001), CA242 ( P =0.018), and CA211 ( P =0.012) were associated with OS of patients through univariate analysis. Multivariate analysis using a Cox regression model showed that only treatment was an independent predictor for OS (conservative treatment; HR=1.861, 95% CI=1.077–3.441; P =0.048). Conclusion Surgical treatment of metastatic lesions may be an alternative choice for CRC patients with BM. Identifying the timing of brain metastases can help to detect this disease early, leading to a better survival outcome.

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Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported controversial results on surgery combined with radiotherapy for CRC patients with BM. 11 Some surgeons recommend surgery combined with radiotherapy as it improves CRC patient survival better than surgery only, and others found no differences between the two treatments. [12][13][14] Prospective studies including more samples should be carried out to assess Previous studies have explored factors associated with prognosis of CRC patients with BM, including extracranial metastases, number of BMs, and treatment of BM; 6,7,15,16 However, conclusions were varied among different studies.…”

Section: Discussionmentioning

confidence: 99%

Factors Prognostic for Brain Metastases from Colorectal Cancer: A Single-Center Experience in China

Wang

Chen

et al. 2021

CMAR

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“…The smallest study population reported on five patients, while the largest study included 475 patients with BM. The analyzed studies are shown in Figure 6 and Table 7 [ 9 , 10 , 11 , 12 , 14 , 15 , 18 , 20 , 23 , 24 , 25 , 26 , 27 , 29 , 34 , 45 , 46 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ].…”

Section: Resultsmentioning

confidence: 99%

“…Four did not report the exact OS. Three focused on a specific metastatic site and five evaluated extracranial metastases in general; these included the studies by Quan et al (2020) (extracranial metastases: 4 months; no extracranial metastases: 6 months), Quan et al (2019) (extracranial metastases: 7 months; no extracranial metastases: 28 months), Del Carpio Huerta et al (extracranial metastases: 7.2 months; no extracranial metastases: 20.9 months), Gu et al (extracranial metastases: 7 months; no extracranial metastases: 13 months), and Noura et al (extracranial metastases: 8 months; no extracranial metastases: 24 months) [ 7 , 9 , 12 , 27 , 45 , 46 , 52 , 55 , 62 , 64 , 65 , 70 ]. Eleven studies reported multiple BM as a risk factor for poor OS.…”

Section: Resultsmentioning

confidence: 99%

Brain Metastases from Colorectal Cancer: A Systematic Review of the Literature and Meta-Analysis to Establish a Guideline for Daily Treatment

Müller

Köhler

Hendricks

et al. 2021

Cancers

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Colorectal cancer (CRC) is the third most common malignancy worldwide. Most patients with metastatic CRC develop liver or lung metastases, while a minority suffer from brain metastases. There is little information available regarding the presentation, treatment, and overall survival of brain metastases (BM) from CRC. This systematic review and meta-analysis includes data collected from three major databases (PubMed, Cochrane, and Embase) based on the key words “brain”, “metastas*”, “tumor”, “colorectal”, “cancer”, and “malignancy”. In total, 1318 articles were identified in the search and 86 studies matched the inclusion criteria. The incidence of BM varied between 0.1% and 11.5%. Most patients developed metastases at other sites prior to developing BM. Lung metastases and KRAS mutations were described as risk factors for additional BM. Patients with BM suffered from various symptoms, but up to 96.8% of BM patients were asymptomatic at the time of BM diagnosis. Median survival time ranged from 2 to 9.6 months, and overall survival (OS) increased up to 41.1 months in patients on a multimodal therapy regimen. Several factors including age, blood levels of carcinoembryonic antigen (CEA), multiple metastases sites, number of brain lesions, and presence of the KRAS mutation were predictors of OS. For BM diagnosis, MRI was considered to be state of the art. Treatment consisted of a combination of surgery, radiation, or systemic treatment.

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“…CRC metastatic to the brain is a highly lethal condition warranting effective intervention (21), whereas the standard treatment modality for BM from CRC has not been established. Usually CRC-BM have been regarded as a terminal event which limited the development of treatment for colorectal cancer brain metastasis (22,23). Previous views hold that blood-brain barrier is considered to prevent most chemotherapy drugs from entering the brain and result in failure of chemotherapy in treatment of BM.…”

Section: Discussionmentioning

confidence: 99%

Treatment modalities and relative survival in patients with brain metastasis from colorectal cancer

Cai

Liang

et al. 2019

BST

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Colorectal cancer (CRC) metastatic to the brain occurs rarely and remains highly lethal in clinical practice. The crude incidence of brain metastases (BM) from CRC is 0.27%, while in metastatic colorectal cancer, it increases to 1.36% (1). Besides, the occurrence rate of asymptomatic BM has been observed to increase simultaneously in past decades (2), which has been attributed to the improvement of multimodality therapy to extend survival of CRC and novel diagnostic radiographic techniques to detect small brain lesions (3,4). Unfortunately, the prognosis for CRC patients developed to BM is rather poor. Patients without any therapeutic intervention will only have a survival period of about 4 weeks after the occurrence of BM (5). In the past, whole brain radiation therapy (WBRT) and neurosurgery were usually used for the treatment of brain metastases (6), but the effect of radiotherapy or neurosurgery alone was unsatisfactory. Patients who underwent WBRT alone had a median survival of only 3-6 months (7,8), and the ability of neurosurgery to improve survival in patients with BM is not as effective as clinicians expected. Currently, the concept of multidisciplinary treatment has been widely accepted in the clinical diagnosis and treatment of CRC liver metastasis and lung metastasis (9,10), and proved that multidisciplinary treatment could bring significant survival benefits to those patients. Nevertheless, in CRC patients with BM, the concept of multidisciplinary treatment was not universal. The decision-making for treatment modalities is still empirical in patients with Summary Standard treatment options for brain metastases (BM) from colorectal cancer (CRC) are controversial. The purpose of this study was to evaluate the efficacy of multidisciplinary treatment modalities and provide optimal therapeutic strategies for selected patients with different clinical characteristics. All eligible patients diagnosed with BM from CRC during the past two decades (1997-2016) were identified in our center. Clinical characteristics, treatment modalities and relative survival were retrospectively analyzed. Median overall survival after the identification of BM was 6 months. The 1-and 2-year survival rates were 29.40% and 5.70%, respectively. On multivariate analysis, the number of BMs, Karnofsky performance score and the treatment modalities were found to be independent prognostic factors (the p-value was 0.006, 0.001 and < 0.001, respectively). In conclusion, multidisciplinary treatment is supported to be the optimal treatment for patients with BM from CRC. For patients with single brain metastases and KPS > 70, neurosurgery combined with chemotherapy could provide an additional survival benefit. For patients with multiple brain metastases or KPS ≤ 70, radiotherapy plus chemotherapy may be appropriate.

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Brain metastases in colorectal cancer: prognostic factors and survival analysis

Abstract: Time to BM diagnosis is shorter in RS CRC. The presence of two or more metastatic extracranial locations and progressive metastatic extracranial disease at the time of BM diagnosis could be bad prognosis factors for CRC BM patients.

Cited by 12 publications

References 31 publications

Factors Prognostic for Brain Metastases from Colorectal Cancer: A Single-Center Experience in China

Factors Prognostic for Brain Metastases from Colorectal Cancer: A Single-Center Experience in China

Brain Metastases from Colorectal Cancer: A Systematic Review of the Literature and Meta-Analysis to Establish a Guideline for Daily Treatment

Treatment modalities and relative survival in patients with brain metastasis from colorectal cancer

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