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Wong CE, Chang Y, Huang CC, Hsu HH, Lai YH, Chang KY, Huang CY, Wang LC, Lee JS, Lee PH. Surgical excision and radiotherapy for brain metastasis from colorectal cancer: How frailty and comorbidity indices influence outcome. Kaohsiung J Med Sci 2024; 40:395-403. [PMID: 38482966 DOI: 10.1002/kjm2.12815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/25/2023] [Accepted: 01/08/2024] [Indexed: 04/10/2024] Open
Abstract
The incidence of brain metastasis (BM) from colorectal cancer (CRC) is increasing. This study aims to identify the clinical prognosticators and evaluate the prognostic validity of common comorbidity indices in patients with BM from CRC. This retrospective single-center study analyzed 93 patients with BM from CRC who received surgical excision and/or radiotherapy. The clinical characteristics and prognostic indices including the 5-item modified frailty index (mFI-5) and prognostic nutritional index (PNI) were calculated from the collected patient data and analyzed. In this study, 66 (71.0%), 10 (10.8%), and 17 (18.3%) patients received whole-brain radiotherapy (WBRT) alone, surgery alone, and surgery plus WBRT, respectively. The median survival of all patients was 3.98 months (IQR: 1.74-7.99). The 2- and 3-year survival rates were 7.4% and 3.7%, respectively. Controlled primary tumor (p = 0.048), solitary BM (p = 0.001), surgery + radiation (p < 0.001), and greater PNI (p = 0.001) were independent predictors of favorable survival. In surgically treated patients, uncontrolled primary tumor (p = 0.006), presence of multiple BM (p < 0.001), and MFI-5 ≥ 2 (p = 0.038) were independent prognosticators. For patients who received WBRT, the presence of two (p = 0.004) or multiple (p < 0.001) BM and PNI (p < 0.001) were independent survival predictors MFI-5, multiple BM, and the status of the primary tumor were independent prognosticators for patients who underwent surgery for CRCBM. For patients who received WBRT, the PNI and the number of BM were independent survival predictors.
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Affiliation(s)
- Chia-En Wong
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu Chang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chen Huang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Hsiang Hsu
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Hsuan Lai
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kwang-Yu Chang
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Chih-Yuan Huang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Liang-Chao Wang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Shun Lee
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Hsuan Lee
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Wei R, Yu G, Wang X, Jiang Z, Guan X. Construction and validation of machine learning models for predicting distant metastases in newly diagnosed colorectal cancer patients: A large-scale and real-world cohort study. Cancer Med 2024; 13:e6971. [PMID: 38491804 PMCID: PMC10943273 DOI: 10.1002/cam4.6971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/22/2023] [Accepted: 11/27/2023] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND More accurate prediction of distant metastases (DM) in patients with colorectal cancer (CRC) would optimize individualized treatment and follow-up strategies. Multiple prediction models based on machine learning have been developed to assess the likelihood of developing DM. METHODS Clinicopathological features of patients with CRC were obtained from the National Cancer Center (NCC, China) and the Surveillance, Epidemiology, and End Results (SEER) database. The algorithms used to create the prediction models included random forest (RF), logistic regression, extreme gradient boosting, deep neural networks, and the K-Nearest Neighbor machine. The prediction models' performances were evaluated using receiver operating characteristic (ROC) curves. RESULTS In total, 200,958 patients, 3241 from NCC and 197,717 CRC from SEER were identified, of whom 21,736 (10.8%) developed DM. The machine-learning-based prediction models for DM were constructed with 12 features remaining after iterative filtering. The RF model performed the best, with areas under the ROC curve of 0.843, 0.793, and 0.806, respectively, on the training, test, and external validation sets. For the risk stratification analysis, the patients were separated into high-, middle-, and low-risk groups according to their risk scores. Patients in the high-risk group had the highest incidence of DM and the worst prognosis. Surgery, chemotherapy, and radiotherapy could significantly improve the prognosis of the high-risk and middle-risk groups, whereas the low-risk group only benefited from surgery and chemotherapy. CONCLUSION The RF-based model accurately predicted the likelihood of DM and identified patients with CRC in the high-risk group, providing guidance for personalized clinical decision-making.
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Affiliation(s)
- Ran Wei
- Department of Colorectal Cancer Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Gastrointestinal Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Guanhua Yu
- Department of Colorectal Cancer Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xishan Wang
- Department of Colorectal Cancer Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zheng Jiang
- Department of Colorectal Cancer Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xu Guan
- Department of Colorectal Cancer Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Franceschi W, Bliggenstorfer J, Sarode AL, Ginesi M, Steinhagen E, Stein SL. Primary Colorectal Tumor Location and Predictors for Metastasis to the Brain. Cureus 2023; 15:e39735. [PMID: 37398830 PMCID: PMC10310402 DOI: 10.7759/cureus.39735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Although rectal cancer is thought to have a higher rate of metastasis to the brain compared with colon cancer, there is limited and contradictory data on the subject. This study aims to determine the prevalence of brain metastasis for colon and rectal cancers (CRC), and to explore associations and predictors of brain metastasis (BM). Methods The 2010-2016 National Cancer Database (NCDB) was queried for patients with stage IV CRC. Patients with missing data on site of metastasis and primary tumor location were excluded. Chi-square test was used for categorical data and multivariate logistic regression analysis was performed to evaluate the predictors of BM. Results Of 108,540 stage IV CRC patients, the prevalence of BM was 1.21% from the right colon, 1.29% from the left colon, and 1.59% from the rectal adenocarcinoma (p<0.001). The presence of lung, bone, and liver metastases were the strongest predictors for BM. Bone and lung metastases increased the odds for BM by 3.87 (95% CI: 3.36-4.46) and 3.38 (95% CI: 3.01-3.80), respectively while the presence of liver metastasis decreased odds for BM by 55% (OR: 0.45; 95% CI: 0.40-0.50). On multivariate analysis, primary tumor location was not predictive of BM. Discussion This study helps to characterize the prevalence and associations of BM from CRC using the NCDB. The correlation between BM and bone and lung metastases, along with negative association of liver metastasis further supports the hypothesis of systemic transmission of tumor cells. Further identification of predictors and correlations with BM may help guide surveillance among patients with advanced CRC.
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Affiliation(s)
- William Franceschi
- Department of General Surgery, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Jonathan Bliggenstorfer
- Department of Surgery, University Hospitals Cleveland Medical Center - University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, USA
| | - Anuja L Sarode
- Department of Surgery, University Hospitals Cleveland Medical Center - University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, USA
| | - Meridith Ginesi
- Department of Surgery, University Hospitals Cleveland Medical Center - University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, USA
| | - Emily Steinhagen
- Department of Surgery, University Hospitals Cleveland Medical Center - University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, USA
| | - Sharon L Stein
- Department of Surgery, University Hospitals Cleveland Medical Center - University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, USA
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Tan Z, Sun W, Li Y, Jiao X, Zhu M, Zhang J, Qing C, Jia Y. Current Progress of EMT: A New Direction of Targeted Therapy for Colorectal Cancer with Invasion and Metastasis. Biomolecules 2022; 12. [PMID: 36551152 DOI: 10.3390/biom12121723] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 11/23/2022] Open
Abstract
Colorectal cancer (CRC) is a common malignant tumor with a high frequency of recurrence and metastasis, which are the major causes of death in patients. The prerequisite for the invasion and metastasis is the strong mobility of CRC cells to transport far away from the original site to the distant organs and tissues, where they settle down and proliferate. It was reported that the epithelial-mesenchymal transition (EMT) is involved in the occurrence and development of various tumors in the entire process of tumor invasion and metastasis. Therefore, as a vital factor for the biological characteristics of tumor cells, EMT markers may serve as prognostic predictors and potential therapeutic targets in CRC. This article mainly reviews the current status of CRC with metastasis, the studies of EMT, the possible relationship of EMT with CRC, as well as the potential targeted therapy.
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Abstract
To investigate the clinical characteristics, survival, prognostic factors, and treatment of brain metastasis (BM) from colorectal cancer (CRC). Twenty-one patients with BM from CRC were retrospectively reviewed. Predictive factors for BM and prognostic factors after the diagnosis of BM were examined by univariate and multivariate COX analysis. The time from the development of extracranial metastases, including lung, bone, and liver, to the occurrence of BM was recorded separately. The median overall survival time was 7 months. In univariate prognostic analysis, median survival with multimodal therapy was better than that with unimodal therapy (10 months vs 3 months, P = .000). In addition, median survival with Karnofsky performance status (KPS) < 70, 1 BM lesion, primary tumor stage of II-III, extracranial lesions < 2, and no extracranial metastasis were much better than the other groups (P < .05 of all). Although there was not a significant difference in median survival between patients receiving combination treatment with bevacizumab and those who did not, treatment with bevacizumab was associated with better survival (10 months vs 5 months, P = .436). The time intervals from bone, liver, and lung metastases to BM were 3, 6.5, and 11 months, respectively. Based on multivariate Cox analysis, KPS and treatment modalities were independent prognosis factors (P = .039 and P = .000, respectively). CRC patients with a high KPS and multimodal treatment have improved survival.
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Affiliation(s)
- Wenxia Li
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Tongsheng Wang
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Yubing Zhu
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Haijiao Yu
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Ling Ma
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Yuhan Ding
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Gao Hong
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Ding Lei
- Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, China
- *Correspondence: Lei Ding, Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, No. 10 Tieyi Road, Beijing 100038, China (e-mail: )
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Chang Y, Wong CE, Lee PH, Huang CC, Lee JS. Survival Outcome of Surgical Resection vs. Radiotherapy in Brain Metastasis From Colorectal Cancer: A Meta-Analysis. Front Med (Lausanne) 2022; 9:768896. [PMID: 35350580 PMCID: PMC8957984 DOI: 10.3389/fmed.2022.768896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of brain metastasis from colorectal cancer (CRC) increases along with the greater survival rate for CRC because of the advances in therapeutic modalities. Local treatment strategies for brain metastasis include surgical resection and radiotherapy. Nevertheless, given the incongruent literature, the optimal therapeutic approach remains to be investigated. This study aims to systematically compare the real-world survival outcome of surgical resection and radiotherapy in patients with brain metastasis from CRC. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines (PROSPERO, ID: CRD42021240200), the Cochrane Library, Embase, and Medline were searched from the inception of the database to August 2021. Meta-analyses were conducted with results pooled using hazard ratios with corresponding 95% CIs to evaluate the overall survival (OS) following local treatment for brain metastasis from CRC. Summary effects were evaluated using a series of random-effect models. Results In this review, 17 retrospective studies comprising 1,438 participants were included. In comparison with radiotherapy, the OS of patients who received brain metastasectomy was generally longer (HR, 0.53; 95% CI, 0.47–0.60). Extracerebral metastases (HR, 1.58; 95% CI, 1.34–1.86) and multiple brain metastases (HR, 1.38; 95% CI, 1.10–1.72) were associated with worse survival outcomes. Conclusions For patients with brain metastasis from CRC, the current real-world evidence demonstrated the survival benefit of aggressive neurosurgical management in suitable patients. Additionally, patients with extracerebral metastases and multiple brain metastases had worse survival outcomes. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=240200.
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Affiliation(s)
- Yu Chang
- Section of Neurosurgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Chia-En Wong
- Section of Neurosurgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Po-Hsuan Lee
- Section of Neurosurgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chen Huang
- Section of Neurosurgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Shun Lee
- Section of Neurosurgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,College of Medicine, Institute of Basic Medical Sciences, National Cheng Kung University, Tainan, Taiwan.,Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Müller S, Köhler F, Hendricks A, Kastner C, Börner K, Diers J, Lock JF, Petritsch B, Germer CT, Wiegering A. Brain Metastases from Colorectal Cancer: A Systematic Review of the Literature and Meta-Analysis to Establish a Guideline for Daily Treatment. Cancers (Basel) 2021; 13:900. [PMID: 33669974 PMCID: PMC7924831 DOI: 10.3390/cancers13040900] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 02/01/2023] Open
Abstract
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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Affiliation(s)
- Sophie Müller
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Franziska Köhler
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Anne Hendricks
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Carolin Kastner
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Kevin Börner
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Johannes Diers
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Johan F. Lock
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
| | - Bernhard Petritsch
- Department of Radiology, University Hospital Wuerzburg, 97084 Wuerzburg, Germany;
| | - Christoph-Thomas Germer
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg, 97084 Wuerzburg, Germany
| | - Armin Wiegering
- Department of General, University Hospital Wuerzburg, Visceral, Transplant, Vascular and Paediatric Surgery, 97084 Wuerzburg, Germany; (S.M.); (F.K.); (A.H.); (C.K.); (K.B.); (J.D.); (J.F.L.); (C.-T.G.)
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg, 97084 Wuerzburg, Germany
- Theodor Boveri Institute, Biocenter, University of Wuerzburg, 97084 Wuerzburg, Germany
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Bliss LA, Strong EA, Gamblin TC. Surgical resectability of multisite metastatic colorectal cancer: Pushing the limits while appropriately selecting patients. J Surg Oncol 2019; 119:623-628. [PMID: 30802312 DOI: 10.1002/jso.25419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 01/26/2023]
Abstract
Management of multisite colorectal metastases is expanding to make curative resection possible for more patients who present with advanced disease. Patient selection, tumor biology, meticulous surgical technique, and thoughtful perioperative care are essential to extending the benefit to patients previously treated with palliative goals of care.
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Affiliation(s)
- Lindsay A Bliss
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Erin A Strong
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - T Clark Gamblin
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Silva IL, Iskandarani M, Hotouras A, Murphy J, Bhan C, Adada B, Wexner SD. A systematic review to assess the management of patients with cerebral metastases secondary to colorectal cancer. Tech Coloproctol 2017; 21:847-852. [PMID: 29124419 DOI: 10.1007/s10151-017-1707-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/11/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) rarely metastasizes to the brain. The incidence of cerebral metastases (CM) is estimated between 1 and 3%. Given the improved survival from advanced CRC as a result of surgical and oncological advances, it is anticipated that the incidence of patients with CM from CRC will rise over the next few years. The aim of this article was to systematically review the treatment options and outcome of patients with CM from CRC. METHODS PubMed and Medline databases were examined using the search words or MESH headings "colorectal" "cancer/carcinoma/adenocarcinoma", "cerebral"/"brain" and "metastases/metastasis". RESULTS CM from CRC are diagnosed on average 28.3 months after the primary tumour. The median survival time following diagnosis is 5.3 months. Surgery (with or without associated radiotherapy), stereotactic radiosurgery, whole brain radiotherapy and best supportive care result in median survival of 10.3, 6.4, 4.4 and 1.8 months, respectively. On average, the 1-year overall survival rate for patients with CM from CRC regardless of the treatment modality is estimated to be around 24%. CONCLUSIONS The prognosis of patients with CM from CRC is dismal. Surgery may increase survival, but the additional benefit of perioperative radiotherapy cannot be ascertained due to paucity of data. Further studies are required to identify the role of the different oncological and surgical therapies and identify those patients likely to benefit most. Identification of patients who are at higher risk of developing brain metastases may be another important area for future research.
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Affiliation(s)
- I L Silva
- Department of Surgery, Whittington Hospital, London, UK
| | - M Iskandarani
- Department of Surgery, The Royal London Hospital, London, UK
| | - A Hotouras
- Department of Surgery, The Royal London Hospital, London, UK.
- National Centre for Bowel Research and Surgical Innovation, Barts and the London, School of Medicine and Dentistry, 2 Newark Street, London, E12AT, UK.
| | - J Murphy
- Department of Surgery, St Mary's Hospital, Imperial College London, London, UK
| | - C Bhan
- Department of Surgery, Whittington Hospital, London, UK
| | - B Adada
- Department of Neurological Surgery, Cleveland Clinic Florida, Fort Lauderdale, FL, USA
| | - S D Wexner
- Digestive Disease Center, Cleveland Clinic Florida, Fort Lauderdale, FL, USA
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Mege D, Sans A, Ouaissi M, Iannelli A, Sielezneff I. Brain metastases from colorectal cancer: characteristics and management. ANZ J Surg 2017; 88:140-145. [PMID: 28687024 DOI: 10.1111/ans.14107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/05/2017] [Accepted: 05/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Brain metastases (BMs) are the most common intracranial neoplasms in adults, but they rarely arise from colorectal cancer (CRC). The objective of this study was to report an overview of the characteristics and current management of CRC BMs. METHODS A systematic review on CRC BMs was performed using Medline database from 1983 to 2015. The search was limited to studies published in English. Review articles, not relevant case report or studies or studies relating to animal and in vitro experiments were excluded. RESULTS BMs occurred in 0.06-4% of patients with CRC. Most BMs were metachronous and were associated with lung (27-92%) and liver (12-80%) metastases. Treatment options depended on the number of BMs, the general conditions of the patient and the presence of other metastases. Most frequent treatment was whole-brain radiotherapy (WBRT) alone (36%), with median overall survival comprised between 2 and 9 months. Median overall survival was better after surgery alone (from 3 to 16.2 months), or combined with WBRT (from 7.6 to 14 months). After stereotactic radiosurgery alone, overall survival could reach 9.5 months. Many favourable prognostic factors were identified, such as high Karnofsky performance status, low recursive partitioning analysis classes, lack of extracranial disease, low number of BMs and possibility to perform surgical treatment. CONCLUSION BMs from CRC are rare. In the presence of favourable prognostic factors, an aggressive management including surgical resection with or without WBRT or stereotactic radiosurgery can improve the overall survival.
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Affiliation(s)
- Diane Mege
- Department of Digestive and General Surgery, Timone Hospital, Aix-Marseille University, Marseille, France
| | - Arnaud Sans
- Department of Digestive and General Surgery, Timone Hospital, Aix-Marseille University, Marseille, France
| | - Mehdi Ouaissi
- Department of Digestive Surgery, University of Tours, Tours, France
| | - Antonio Iannelli
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France
| | - Igor Sielezneff
- Department of Digestive and General Surgery, Timone Hospital, Aix-Marseille University, Marseille, France
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Aprile G, Casagrande M, De Maglio G, Fontanella C, Rihawi K, Bonotto M, Pisa FE, Tuniz F, Pizzolitto S, Fasola G. Comparison of the molecular profile of brain metastases from colorectal cancer and corresponding primary tumors. Future Oncol 2016; 13:135-144. [PMID: 27578453 DOI: 10.2217/fon-2016-0196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AIM Little is known about molecular biology of brain metastasis (BM) from colorectal cancer and its concordance with matched primary tumors. MATERIALS & METHODS We identified 56 consecutive colorectal cancer patients who underwent neurosurgical resection of BM. Tumor samples were tested for KRAS, NRAS, BRAF and PIK3CA. The molecular profile of the brain lesion was compared with the corresponding primary tumor. RESULTS The molecular profile concordance rate was 95.1%. Median survival after neurosurgery was 5.5 months (95% CI: 4.7-6.3); median overall survival was 24.0 months (95% CI: 15.6-32.4). CONCLUSION In this cohort, we report a high frequency of KRAS mutations and a very high concordance rate between the molecular status of BM and that of matched primary tumors.
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Affiliation(s)
- Giuseppe Aprile
- Department of Oncology, University & General Hospital, Piazzale S Maria della Misericordia 15, 33100, Udine, Italy
| | - Mariaelena Casagrande
- Department of Oncology, University & General Hospital, Piazzale S Maria della Misericordia 15, 33100, Udine, Italy
| | - Giovanna De Maglio
- Department of Pathology, University & General Hospital, Piazzale S Maria della Misericordia 15, 33100, Udine, Italy
| | - Caterina Fontanella
- Department of Oncology, University & General Hospital, Piazzale S Maria della Misericordia 15, 33100, Udine, Italy
| | - Karim Rihawi
- Department of Oncology, University & General Hospital, Piazzale S Maria della Misericordia 15, 33100, Udine, Italy
| | - Marta Bonotto
- Department of Oncology, University & General Hospital, Piazzale S Maria della Misericordia 15, 33100, Udine, Italy
| | - Federica E Pisa
- Institute of Hygiene & Clinical Epidemiology, University & General Hospital, Piazzale S Maria della Misericordia 15, 33100, Udine, Italy
| | - Francesco Tuniz
- Department of Neurosurgery, University & General Hospital, Piazzale S Maria della Misericordia 15, 33100, Udine, Italy
| | - Stefano Pizzolitto
- Department of Pathology, University & General Hospital, Piazzale S Maria della Misericordia 15, 33100, Udine, Italy
| | - Gianpiero Fasola
- Department of Oncology, University & General Hospital, Piazzale S Maria della Misericordia 15, 33100, Udine, Italy
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Christensen TD, Spindler KLG, Palshof JA, Nielsen DL. Systematic review: brain metastases from colorectal cancer--Incidence and patient characteristics. BMC Cancer 2016; 16:260. [PMID: 27037031 PMCID: PMC4818396 DOI: 10.1186/s12885-016-2290-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/22/2016] [Indexed: 02/07/2023] Open
Abstract
Background Brain metastases (BM) from colorectal cancer (CRC) are a rare event. However, the implications for affected patients are severe, and the incidence has been reported to be increasing. For clinicians, knowledge about the characteristics associated with BM is important and could lead to earlier diagnosis and improved survival. Method In this paper, we describe the incidence as well as characteristics associated with BM based on a systematic review of the current literature, following the PRISMA guidelines. Results We show that the incidence of BM in CRC patients ranges from 0.6 to 3.2 %. BM are a late stage phenomenon, and young age, rectal primary and lung metastases are associated with increased risk of developing BM. Molecular markers such as KRAS, BRAF, NRAS mutation as well as an increase in CEA and CA19.9 levels are suggested predictors of brain involvement. However, only KRAS mutations are reasonably well investigated and associated with an increased risk of BM. Conclusion The incidence of BM from CRC is 0.6 to 3.2 % and did not seem to increase over time. Development of BM is associated with young age, lung metastases, rectal primary and KRAS mutation. Increased awareness of brain involvement in patients with these characteristics is necessary.
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Affiliation(s)
- Troels Dreier Christensen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730, Herlev, Denmark.
| | | | - Jesper Andreas Palshof
- Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730, Herlev, Denmark
| | - Dorte Lisbet Nielsen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730, Herlev, Denmark
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Lemke J, Scheele J, Kapapa T, von Karstedt S, Wirtz CR, Henne-Bruns D, Kornmann M. Brain metastases in gastrointestinal cancers: is there a role for surgery? Int J Mol Sci 2014; 15:16816-30. [PMID: 25247579 PMCID: PMC4200819 DOI: 10.3390/ijms150916816] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/11/2014] [Accepted: 09/15/2014] [Indexed: 12/15/2022] Open
Abstract
About 10% of all cancer patients will develop brain metastases during advanced disease progression. Interestingly, the vast majority of brain metastases occur in only three types of cancer: Melanoma, lung and breast cancer. In this review, we focus on summarizing the prognosis and impact of surgical resection of brain metastases originating from gastrointestinal cancers such as esophageal, gastric, pancreatic and colorectal cancer. The incidence of brain metastases is <1% in pancreatic and gastric cancer and <4% in esophageal and colorectal cancer. Overall, prognosis of these patients is very poor with a median survival in the range of only months. Interestingly, a substantial number of patients who had received surgical resection of brain metastases showed prolonged survival. However, it should be taken into account that all these studies were not randomized and it is likely that patients selected for surgical treatment presented with other important prognostic factors such as solitary brain metastases and exclusion of extra-cranial disease. Nevertheless, other reports have demonstrated long-term survival of patients upon resection of brain metastases originating from gastrointestinal cancers. Thus, it appears to be justified to consider aggressive surgical approaches for these patients.
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Affiliation(s)
- Johannes Lemke
- Clinic of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm 89071, Germany.
| | - Jan Scheele
- Clinic of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm 89071, Germany.
| | - Thomas Kapapa
- Clinic of Neurosurgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm 89071, Germany.
| | - Silvia von Karstedt
- UCL Cancer Institute, University College London, 72 Huntley Street, London WC1E 6DD, UK.
| | - Christian Rainer Wirtz
- Clinic of Neurosurgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm 89071, Germany.
| | - Doris Henne-Bruns
- Clinic of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm 89071, Germany.
| | - Marko Kornmann
- Clinic of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm 89071, Germany.
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Aprile G, De Maglio G, Menis J, Casagrande M, Tuniz F, Pisa EF, Fontanella C, Skrap M, Beltrami AC, Fasola G, Pizzolitto S. HER-2 Expression in Brain Metastases from Colorectal Cancer and Corresponding Primary Tumors: A Case Cohort Series. Int J Mol Sci 2013; 14:2370-87. [PMID: 23348930 DOI: 10.3390/ijms14022370] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 01/09/2013] [Accepted: 01/12/2013] [Indexed: 12/22/2022] Open
Abstract
Brain metastases (BM) from colorectal cancer (CRC) are a rare but increasing event. Surgical resection of oligometastatic disease, including BM, may produce a survival benefit in selected patients. Previous studies described the HER-2 expression patterns in CRC patients, but its prognostic role still remains controversial. Information on the HER-2 expression in BM from CRC is currently lacking. Among the over 500 patients treated at our Department of Neurosurgery in the last 13 years (1999–2012), we identified a cohort of 50 consecutive CRC patients resected for BM. Clinical data were retrospectively reviewed using electronic hospital charts and surgical notes. Formalin-fixed, paraffin-embedded tissue samples were retrieved and histologically reviewed. HER-2 status was assessed on 4-μm sections by HerceptTest™, and scored by two pathologists according to gastric cancer HER-2 status guidelines. In score 2+ cases HER-2 gene copy number was analyzed by FISH, performed using the PathVysion HER-2 DNA Probe Kit. Median age at time of BM resection was 65 years (35–82); most patients were males (60%) with a good performance status. The majority of the BM were single (74%) and sited in the supratentorial area (64%); 2–4 lesions were diagnosed in 9 patients (18%), and >4 in 3 patients (6%). The rate of HER-2 positivity (defined as IHC score 3+ or IHC score 2+ and FISH gene amplification) was 8.1% for the primary CRC tumors and 12% for their corresponding BM. The concordance rate between primary tumors and matched BM was 89%. Median overall survival after neurosurgery was 6.5 months for HER-2 IHC score 0 vs. 4.6 months for HER-2 IHC score 1+/2+/3+; the difference was statistically significant (p = 0.01, Log-rank test). HER-2 positivity of our case cohort was low but comparable to literature. Concordance rate of HER-2 expression between BM and corresponding primary tumors is high and similar to those reported for breast and gastric cancers. Our data suggest a potential negative prognostic value of HER-2 expression in brain lesions from CRC.
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