Skip to main content
Erschienen in: Gastric Cancer 5/2020

28.04.2020 | Original Article

Brain metastases in patients with upper gastrointestinal cancer is associated with proximally located adenocarcinoma and lymph node metastases

verfasst von: Kazuto Harada, Hyunsoo Hwang, Xuemei Wang, Ahmed Abdelhakeem, Masaaki Iwatsuki, Mariela A. Blum Murphy, Dipen M. Maru, Brian Weston, Jeffrey H. Lee, Jane E. Rogers, Allison Trail, Namita Shanbhag, Meina Zhao, Manoop S. Bhutani, Quynh-Nhu Nguyen, Stephen G. Swisher, Naruhiko Ikoma, Prajnan Das, Wayne L. Hofstetter, Brian D. Badgwell, Jaffer A. Ajani

Erschienen in: Gastric Cancer | Ausgabe 5/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

As cancer patients are surviving longer, more patients manifest brain metastases (BRMs). However, the rate of BRMs from upper gastrointestinal cancer is unclear. We therefore evaluated the frequency and prognostic effect of BRMs in this setting.

Methods

We analyzed records of 2348 patients who were treated between January 2002 and December 2016 for upper gastrointestinal cancer, including esophageal and gastroesophageal junction adenocarcinoma (EAC; proximal EAC, Siewert types I and II), esophageal squamous cell carcinoma (ESCC), and gastric adenocarcinoma (GAC; Siewert type III and stomach cancer) in our Gastrointestinal Medical Oncology Database. Frequency, risk factors, and survival after BRMs were evaluated.

Results

Of 2348 patients, 68 (2.9%) had BRMs upon follow-up. The BRM rates were as follows: proximal EAC, 4.8%; Siewert type I, 5.9%; Siewert type II, 2.2%; Siewert type III, 0.7%; ESCC: 1.2%; and stomach cancer, 0%. Among EAC patients, Siewert type I and lymph node metastases were independent the risk factors for BRMs in the multivariable analysis. The median overall survival (OS) in the 68 patients with BRMs was only 1.16 years (95% CI 0.78–1.61). However, OS for patients who had a solitary BRM, who had BRM but no other distant metastasis, or who underwent surgery or stereotactic radiosurgery favorable.

Conclusion

Patients with proximally located adenocarcinoma, or with lymph node metastases are at a higher risk for BRMs and patients fare better after treatment of isolated BRM.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Global Burden of Disease Cancer C, Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease study. JAMA Oncol. 2017;3:524–48.CrossRef Global Burden of Disease Cancer C, Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease study. JAMA Oncol. 2017;3:524–48.CrossRef
2.
Zurück zum Zitat Ajani JA, D'Amico TA, Almhanna K, Bentrem DJ, Besh S, Chao J, et al. Esophageal and esophagogastric junction cancers, version 1.2015. J Natl Compr Canc Netw. 2015;13:194–227.CrossRef Ajani JA, D'Amico TA, Almhanna K, Bentrem DJ, Besh S, Chao J, et al. Esophageal and esophagogastric junction cancers, version 1.2015. J Natl Compr Canc Netw. 2015;13:194–227.CrossRef
3.
Zurück zum Zitat Davis FG, Dolecek TA, McCarthy BJ, Villano JL. Toward determining the lifetime occurrence of metastatic brain tumors estimated from 2007 United States cancer incidence data. Neuro Oncol. 2012;14:1171–7.CrossRef Davis FG, Dolecek TA, McCarthy BJ, Villano JL. Toward determining the lifetime occurrence of metastatic brain tumors estimated from 2007 United States cancer incidence data. Neuro Oncol. 2012;14:1171–7.CrossRef
4.
Zurück zum Zitat Cagney DN, Martin AM, Catalano PJ, Redig AJ, Lin NU, Lee EQ, et al. Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study. Neuro Oncol. 2017;19(11):1511–21.CrossRef Cagney DN, Martin AM, Catalano PJ, Redig AJ, Lin NU, Lee EQ, et al. Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study. Neuro Oncol. 2017;19(11):1511–21.CrossRef
5.
Zurück zum Zitat Kothari N, Mellon E, Hoffe SE, Frakes J, Shridhar R, Pimiento J, et al. Outcomes in patients with brain metastasis from esophageal carcinoma. J Gastrointest Oncol. 2016;7:562–9.CrossRef Kothari N, Mellon E, Hoffe SE, Frakes J, Shridhar R, Pimiento J, et al. Outcomes in patients with brain metastasis from esophageal carcinoma. J Gastrointest Oncol. 2016;7:562–9.CrossRef
6.
Zurück zum Zitat Welch G, Ross HJ, Patel NP, Jaroszewski DE, Fleischer DE, Rule WG, et al. Incidence of brain metastasis from esophageal cancer. Dis Esophagus. 2017;30:1–6.CrossRef Welch G, Ross HJ, Patel NP, Jaroszewski DE, Fleischer DE, Rule WG, et al. Incidence of brain metastasis from esophageal cancer. Dis Esophagus. 2017;30:1–6.CrossRef
7.
Zurück zum Zitat Wadhwa R, Taketa T, Correa AM, Sudo K, Campagna MC, Blum MA, et al. Incidence of brain metastases after trimodality therapy in patients with esophageal or gastroesophageal cancer: implications for screening and surveillance. Oncology. 2013;85:204–7.CrossRef Wadhwa R, Taketa T, Correa AM, Sudo K, Campagna MC, Blum MA, et al. Incidence of brain metastases after trimodality therapy in patients with esophageal or gastroesophageal cancer: implications for screening and surveillance. Oncology. 2013;85:204–7.CrossRef
8.
Zurück zum Zitat Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. AJCC cancer staging manual. 8th ed. New York: Springer; 2017.CrossRef Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. AJCC cancer staging manual. 8th ed. New York: Springer; 2017.CrossRef
9.
Zurück zum Zitat Ajani JA, D'Amico TA, Almhanna K, Bentrem DJ, Chao J, Das P, et al. Gastric cancer, version 3.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016;14:1286–312.CrossRef Ajani JA, D'Amico TA, Almhanna K, Bentrem DJ, Chao J, Das P, et al. Gastric cancer, version 3.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016;14:1286–312.CrossRef
10.
Zurück zum Zitat Weinberg JS, Suki D, Hanbali F, Cohen ZR, Lenzi R, Sawaya R. Metastasis of esophageal carcinoma to the brain. Cancer. 2003;98:1925–33.CrossRef Weinberg JS, Suki D, Hanbali F, Cohen ZR, Lenzi R, Sawaya R. Metastasis of esophageal carcinoma to the brain. Cancer. 2003;98:1925–33.CrossRef
11.
Zurück zum Zitat Ogawa K, Toita T, Sueyama H, Fuwa N, Kakinohana Y, Kamata M, et al. Brain metastases from esophageal carcinoma: natural history, prognostic factors, and outcome. Cancer. 2002;94:759–64.CrossRef Ogawa K, Toita T, Sueyama H, Fuwa N, Kakinohana Y, Kamata M, et al. Brain metastases from esophageal carcinoma: natural history, prognostic factors, and outcome. Cancer. 2002;94:759–64.CrossRef
12.
Zurück zum Zitat Song Z, Lin B, Shao L, Zhang Y. Brain metastases from esophageal cancer: clinical review of 26 cases. World Neurosurg. 2014;81:131–5.CrossRef Song Z, Lin B, Shao L, Zhang Y. Brain metastases from esophageal cancer: clinical review of 26 cases. World Neurosurg. 2014;81:131–5.CrossRef
13.
Zurück zum Zitat Fidler IJ. The biology of brain metastasis: challenges for therapy. Cancer J. 2015;21:284–93.CrossRef Fidler IJ. The biology of brain metastasis: challenges for therapy. Cancer J. 2015;21:284–93.CrossRef
14.
Zurück zum Zitat Cancer Genome Atlas Research N, Analysis Working Group, Asan U, Agency BCC, Women's H Brigham I Broad, et al. Integrated genomic characterization of oesophageal carcinoma. Nature. 2017;541:169–75.CrossRef Cancer Genome Atlas Research N, Analysis Working Group, Asan U, Agency BCC, Women's H Brigham I Broad, et al. Integrated genomic characterization of oesophageal carcinoma. Nature. 2017;541:169–75.CrossRef
15.
Zurück zum Zitat Limon D, Gal O, Gordon N, Katz L, Perl G, Purim O, et al. Brain metastasis in gastroesophageal adenocarcinoma and HER2 status. J Neurooncol. 2018;138:315–20.CrossRef Limon D, Gal O, Gordon N, Katz L, Perl G, Purim O, et al. Brain metastasis in gastroesophageal adenocarcinoma and HER2 status. J Neurooncol. 2018;138:315–20.CrossRef
16.
Zurück zum Zitat Altaha R, Crowell E, Hobbs G, Higa G, Abraham J. Increased risk of brain metastases in patients with HER-2/neu-positive breast carcinoma. Cancer. 2005;103:442–3.CrossRef Altaha R, Crowell E, Hobbs G, Higa G, Abraham J. Increased risk of brain metastases in patients with HER-2/neu-positive breast carcinoma. Cancer. 2005;103:442–3.CrossRef
17.
Zurück zum Zitat Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322:494–500.CrossRef Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322:494–500.CrossRef
Metadaten
Titel
Brain metastases in patients with upper gastrointestinal cancer is associated with proximally located adenocarcinoma and lymph node metastases
verfasst von
Kazuto Harada
Hyunsoo Hwang
Xuemei Wang
Ahmed Abdelhakeem
Masaaki Iwatsuki
Mariela A. Blum Murphy
Dipen M. Maru
Brian Weston
Jeffrey H. Lee
Jane E. Rogers
Allison Trail
Namita Shanbhag
Meina Zhao
Manoop S. Bhutani
Quynh-Nhu Nguyen
Stephen G. Swisher
Naruhiko Ikoma
Prajnan Das
Wayne L. Hofstetter
Brian D. Badgwell
Jaffer A. Ajani
Publikationsdatum
28.04.2020
Verlag
Springer Singapore
Erschienen in
Gastric Cancer / Ausgabe 5/2020
Print ISSN: 1436-3291
Elektronische ISSN: 1436-3305
DOI
https://doi.org/10.1007/s10120-020-01075-3

Weitere Artikel der Ausgabe 5/2020

Gastric Cancer 5/2020 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.