目的:本研究旨在探讨临床特点,预后因素,生存时间,以及结直肠癌(CRC)脑转移(BM)的治疗结果。
方法:回顾性分析25例结直肠癌BM患者的临床特点。记录诊断CRC后BM发生的时间。同时,从肺发生的时间,骨头,肝脏,和其他颅外转移到BM的发生也被记录。我们评估了影响BM发生时间的时间因素以及BM诊断后的潜在预后因素。对手术为主的综合治疗患者的影响,以放疗为主的综合治疗,和共同用药也进行了评估。
结果:在来自CRC的BM患者中,肺转移(13/25)的发生频率高于肝转移(8/25)和骨转移(6/25)。BM发展的中位时间要短得多(3.7vs.25.3个月,p=0.027),大脑是转移的起点。中位总生存期为9.9个月。诊断BM和骨之间的间隔,肝脏,肺转移持续3、6.5和11个月,分别。单纯BM患者的脑损害发生率较高(88.9%),而那些有颅外转移的患者的幕下转移发生率为62.5%。差异有统计学意义(p<0.05)。67岁以下患者BM发生时间分别为16.1个月和30.1个月,分别。它们之间的差异有统计学意义(p=0.043)。左侧和右侧结肠癌的BM时间分别为26.5和7.8个月,代表统计学上的显著差异(p=0.015)。切除和不切除原发性病变的患者的BM起效时间分别为25.4和4.5个月。显示了统计学上的显著差异(p=0.007)。单因素分析显示患者预后与KPS评分有关,BM的数量,治疗方法,肺转移的发生(p<0.05)。多因素分析显示,治疗方式和肺转移是合并BM的CRC患者的独立预后因素。右侧有BM的CRC患者预后不良(8.1与10.2个月,p=0.31)。尽管使用和不使用贝伐单抗联合治疗的患者的中位生存时间没有显着差异,贝伐单抗治疗与更好的生存时间相关(9.9vs.7.1个月,p=0.27)。
结论:左侧CRC患者,尤其是那些有肺转移的人,容易发生脑转移,以脑转移为第一转移部位的患者幕上转移率较高。年轻的右半结肠癌患者和未进行原发灶切除的患者发生BM的时间较短。结直肠肺转移患者,尤其是那些有右边CRC的年轻人,需要密切的BM影像监测。有BM和肺转移的CRC患者预后较差,以手术为主的综合治疗可显着延长患者的生存时间。
OBJECTIVE: The study aimed to investigate the clinical characteristics, prognostic factors, survival times, and therapy outcomes of brain metastases (BM) from colorectal cancer (CRC).
METHODS: The clinical characteristics of 25 patients with BM from CRC were retrospectively analyzed. The time of the occurrence of BM after diagnosis of CRC was recorded. Meanwhile, the time from the occurrence of lung, bone, liver, and other extracranial metastases to the occurrence of BM was also recorded. We evaluate the time factors affecting the length of the occurrence of BM and the potential prognostic factors after BM diagnosis. The influences of patients undergoing surgery-based comprehensive treatment, radiotherapy-based comprehensive treatment, and co-medication were also assessed.
RESULTS: In patients with BM from CRC, lung metastases (13/25) occurred at a higher frequency than liver metastases (8/25) and bone metastases (6/25). The median time to the development of BM was much shorter (3.7 vs. 25.3 months, p = 0.027), with the brain being the origin site for the metastasis. The median overall survival reached 9.9 months. The interval between diagnosis of BM and bone, liver, and lung metastasis remains 3, 6.5, and 11 months, respectively. The brain lesions of patients with BM alone had higher rates in supratentorial (88.9%), while those with extracranial metastasis had a 62.5% incidence of infratentorial metastasis. The difference was statistically significant (p < 0.05). The time of occurrence of BM in patients aged 67 years and younger was 16.1 and 30.1 months, respectively. The differences between them were statistically significant (p = 0.043). The BM time for left- and right-sided colon cancer were 26.5 and 7.8 months, representing a statistically significant difference (p = 0.015). The time to onset of BM for patients with and without the resection of primary lesions was 25.4 and 4.5 months. Statistically significant differences are shown (p = 0.007). Univariate analysis demonstrated that the prognosis of patients was related to the KPS score, the number of BM, the treatment methods, and the occurrence of lung metastasis (p < 0.05). The multivariate analysis revealed that the treatment modality and lung metastasis were independent prognostic factors for CRC patients with BM. Right-sided CRC patients with BM have a poor prognosis (8.1 vs. 10.2 months, p = 0.31). Although median survival time was not significantly different between patients with and without bevacizumab combination therapy, bevacizumab therapy is associated with a better survival time (9.9 vs. 7.1 months, p = 0.27).
CONCLUSIONS: Patients with left-sided CRC, especially those with lung metastases, are prone to brain metastases, and patients with brain metastases as the first metastatic site have a higher rate of supratentorial metastases. Young patients with right hemicolon cancer and patients who have not undergone primary lesion resection have a shorter time for the occurrence of BM. Patients with colorectal lung metastases, especially those young with right-sided CRC, require close imaging surveillance of BM. The prognosis of CRC patients with BM and lung metastases is poor, and comprehensive treatment based on surgery could significantly prolong patients\' survival time.