The clinical and pathological features of 133 colorectal cancer patients with brain metastasis: a multicenter retrospective analysis of the Gastrointestinal Tumors Working Committee of the Turkish Oncology Group (TOG)

Abstract

Brain metastasis in colorectal cancer is highly rare. In the present study, we aimed to determine the frequency of brain metastasis in colorectal cancer patients and to establish prognostic characteristics of colorectal cancer patients with brain metastasis. In this cross-sectional study, the medical files of colorectal cancer patients with brain metastases who were definitely diagnosed by histopathologically were retrospectively reviewed. Brain metastasis was detected in 2.7 % (n = 133) of 4,864 colorectal cancer patients. The majority of cases were male (53 %), older than 65 years (59 %), with rectum cancer (56 %), a poorly differentiated tumor (70 %); had adenocarcinoma histology (97 %), and metachronous metastasis (86 %); received chemotherapy at least once for metastatic disease before brain metastasis developed (72 %), had progression with lung metastasis before (51 %), and 26 % (n = 31) of patients with extracranial disease at time the diagnosis of brain metastasis had both lung and bone metastases. The mean follow-up duration was 51 months (range 5-92), and the mean survival was 25.8 months (95 % CI 20.4-29.3). Overall survival rates were 81 % in the first year, 42.3 % in the third year, and 15.7 % in the fifth year. In multiple variable analysis, the most important independent risk factor for overall survival was determined as the presence of lung metastasis (HR 1.43, 95 % CI 1.27-4.14; P = 0.012). Brain metastasis develops late in the period of colorectal cancer and prognosis in these patients is poor. However, early screening of brain metastases in patients with lung metastasis may improve survival outcomes with new treatment modalities.

Risk factors for brain metastases in patients with metastatic colorectal cancer

“…Specific gene mutations in the tumor could also potentially lead to an increased risk of BM. Mutation in the PIK3CA, RAS (KRAS and NRAS) and BRAF genes have all been investigated, but mostly in smaller studies [12][13][14][15][16][17], and only RAS mutations have been shown to be significantly associated with BM in two studies [12,13]. However, the few studies examining the predictive potential of characteristics and mutations on later BM development in patients with CRC are small and retrospective.…”

Brain metastases from colorectal cancer: characteristics and management

“…There was a regular relationship between the presence of lung metastases and the subsequent development of BMs . Other extracranial metastases were reported in up to 76% of patients, including bone (5–26%), lymph nodes (7–36%) and peritoneum (3–25%) …”

“…There were 1154 males (56%) and 822 females (40%). Median age varied from 51 (41–89) to 70 (55–80) years.…”

“…Most BMs were metachronous (66–92%), occurring between 19 (7–97) and 41.5 (0–75) months after primary CRC (Table ). Single BMs were reported in 54% of overall series, from 11% to 100% of cases (Table ). Location of BMs was more frequently supratentorial (overall rate = 58%; from 36% to 73% of cases).…”

“…There was a regular relationship between the presence of lung metastases and the subsequent development of BMs. 49 Other extracranial metastases were reported in up to 76% of patients, including bone (5-26%), 42,46 lymph nodes (7-36%) 24,26 and peritoneum (3-25%). 15,45 Characteristics of CRC BMs Most BMs were metachronous (66-92%), 18,28,35,[39][40][41] occurring between 19 (7-97) 17 and 41.5 (0-75) 35 months after primary CRC (Table 1).…”