Bone metastasis predicts poor prognosis of patients with brain metastases from colorectal carcinoma post aggressive treatment.
Bone metastasis predicts poor prognosis of patients with brain metastases from colorectal carcinoma post aggressive treatment.
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骨转移预示结直肠癌脑转移患者积极治疗后预后不良
DOI：
10.2147/cmar.s169563
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发表时间：
2018
影响因子：
3.3
通讯作者：
Mou YG
中科院分区：
文献类型：
--
作者：
Duan H;He ZQ;Guo CC;Li JH;Wang J;Zhu Z;Sai K;Chen ZP;Jiang XB;Mou YG
目的 结直肠癌 (CRC) 患者出现脑转移 (BM) 通常与晚期疾病相关；然而，接受积极治疗的一部分患者可以获得令人满意的预后。本研究旨在调查接受积极治疗的 BM CRC 患者的预后因素。患者和方法对伴有 BM 的 CRC 患者进行回顾性分析。进行生存分析是为了确定整个患者队列和接受积极治疗的患者亚组中的潜在预后因素。积极的治疗包括手术切除、放疗和/或化疗。总生存期定义为从诊断 BM 到死亡或到最后一次随访日期之间的时间。结果 共有 78 例 CRC 患者被确诊为 BM。其中 68 人在进行 BM 诊断时已出现颅外转移。颅外转移最常见的部位是肺（n=51，65.4%），其次是肝（n=25，32.1%）和骨（n=12，15.4%）。 51 名接受积极治疗的患者的总生存期明显长于接受姑息治疗的患者（14.1 个月 vs 2.0 个月，P<0.0001）。应用多变量分析，结果显示积极治疗（n=51）、递归分区分析I/II级（风险比[HR]=0.27，95% CI：0.12-0.6，P=0.001）和较少BM（HR=0.4，95% CI：0.21-0.78，P=0.07）预测更长的生存期。相反，在诊断 BM 时存在骨转移，而不是肺或肝转移（HR=2.38，95% CI：1.08-5.28，P=0.032）预示预后不良。结论 虽然患有 BM 的 CRC 患者的预后通常很差，但那些体能状态良好且脑部病变很少的患者对积极治疗有反应，而那些诊断 BM 时已发生骨转移的患者，即使积极治疗，生存率也相对较低。
Purpose The presence of brain metastasis (BM) in patients with colorectal cancer (CRC) is usually associated with terminal-stage illness; however, a subgroup of patients receiving aggressive treatment can have a satisfactory prognosis. This study was designed to investigate the profile of prognostic factors in CRC patients with BM treated aggressively. Patients and methods CRC patients with BM were retrospectively reviewed. Survival analysis was performed to identify potential prognostic factors in the entire cohort of patients and a subgroup of patients treated aggressively. Aggressive treatments included surgical resection, radiotherapy, and/or chemotherapy. Overall survival was defined as the time between the diagnosis of BM and death or until the date of the last follow-up visit. Results A total of 78 CRC patients were confirmed as having BM. Sixty-eight of them had extracranial metastases at the time of their BM diagnosis. The most common sites of extracranial metastases were lung (n=51, 65.4%), followed by liver (n=25, 32.1%) and bone (n=12, 15.4%). Fifty-one patients who were treated aggressively had significantly longer overall survival than those who accepted palliative care (14.1 months vs 2.0 months, P<0.0001). Multivariate analysis was applied, and the results showed that aggressive treatment (n=51), recursive partitioning analysis class I/II (hazard ratio [HR]=0.27, 95% CI: 0.12–0.6, P=0.001), and fewer BM (HR=0.4, 95% CI: 0.21–0.78, P=0.07) predicted longer survival. In contrast, the presence of bone metastasis, rather than lung or liver metastasis, at the time of diagnosis of BM (HR=2.38, 95% CI: 1.08–5.28, P=0.032) predicted a poor prognosis. Conclusions Although the prognosis of CRC patients having BM is frequently very poor, those with good performance status and few brain lesions responded to aggressive treatment, while those with bone metastasis at the time of diagnosis of BM had relatively dismal survival rates, even when treated aggressively.