Marlies Michl1, Johannes Thurmaier2, Gabriele Schubert-Fritschle3, Max Wiedemann3, Rüdiger P Laubender4, Natascha C Nüssler5, Reinhard Ruppert5, Jörg Kleeff6, Wolfgang Schepp7, Clemens Reuter8, Florian Löhe9, Meinolf Karthaus10, Jens Neumann11, Thomas Kirchner11, Jutta Engel12, Volker Heinemann2. 1. Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich (CCCM), Ludwig-Maximilians-University of Munich, Munich, Germany. Electronic address: Marlies.Michl@med.uni-muenchen.de. 2. Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich (CCCM), Ludwig-Maximilians-University of Munich, Munich, Germany. 3. Munich Cancer Registry (MCR), IBE / Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany. 4. Institute of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University of Munich, Munich, Germany. 5. Department of Surgery, Klinikum Neuperlach, Städtisches Klinikum München, Munich, Germany. 6. Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany. 7. Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Klinikum Bogenhausen, Städtisches Klinikum München, Munich, Germany. 8. Department of Surgery, Krankenhaus Barmherzige Brüder München, Munich, Germany. 9. Department of Surgery, Klinikum Landshut, Landshut, Germany. 10. Department of Hematology, Oncology and Palliative Care, Städtisches Klinikum Harlaching und Neuperlach, Munich, Germany. 11. Institute of Pathology, Ludwig-Maximilians-University of Munich, Munich, Germany. 12. Munich Cancer Registry (MCR), IBE / Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany; Institute of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University of Munich, Munich, Germany.
Abstract
BACKGROUND: The purpose of the study was to characterize the rare cohort of patients (pts) with metastatic colorectal cancer (mCRC) and brain metastasis (BM) and to identify prognostic subgroups. PATIENTS AND METHODS: In collaboration with the Munich Cancer Registry, pts with mCRC and BM who were diagnosed between 1998 and 2011 were identified. Survival from the time of first diagnosis of colorectal cancer (CRC) (OS-1), from the time of diagnosis of metastatic disease (OS-2) and of BM (OS-3) was calculated regarding (1) the temporal occurrence of extra- and intracranial metastasis (meta- vs. synchronous) and (2) tumor and patient characteristics. For survival analysis the Kaplan-Meier estimator and Cox regression models were used. RESULTS: A total of 228 pts (134 male [59%], 94 female [41%]) were identified. The median age was 63 years (142 pts [62%] were 65 years of age or younger). Most pts presented with primary tumors staged T3/4, N+, Grade 2. The primary tumor was located predominantly in the left colon (155 pts; 68%), especially in the rectum (95 pts; 42%). Median OS-1 was 35.6 months (95% confidence interval [CI], 30.1-41.1 months), OS-2 was 16.5 months (95% CI, 13.9-19.1 months), and OS-3 was 2.0 months (95% CI, 1.5-2.5 months). Median time from first CRC diagnosis to BM was 29.2 months. Subsequent BM after extracranial metastasis were observed in 184 pts (80.7%), whereas 31 pts (13.6%) presented with solitary BM. Univariate analysis did not reveal a prognostic variable for overall survival after diagnosis of BM. CONCLUSION: This study presents the largest number of pts with mCRC and BM analyzed to date. The results show that most mCRC pts develop BM as a late step in the course of disease. Median time from first CRC diagnosis to BM is 29.2 months. Only a few pts were diagnosed with BM early in the disease or with solitary BM. When BM is present survival is poor.
BACKGROUND: The purpose of the study was to characterize the rare cohort of patients (pts) with metastatic colorectal cancer (mCRC) and brain metastasis (BM) and to identify prognostic subgroups. PATIENTS AND METHODS: In collaboration with the Munich Cancer Registry, pts with mCRC and BM who were diagnosed between 1998 and 2011 were identified. Survival from the time of first diagnosis of colorectal cancer (CRC) (OS-1), from the time of diagnosis of metastatic disease (OS-2) and of BM (OS-3) was calculated regarding (1) the temporal occurrence of extra- and intracranial metastasis (meta- vs. synchronous) and (2) tumor and patient characteristics. For survival analysis the Kaplan-Meier estimator and Cox regression models were used. RESULTS: A total of 228 pts (134 male [59%], 94 female [41%]) were identified. The median age was 63 years (142 pts [62%] were 65 years of age or younger). Most pts presented with primary tumors staged T3/4, N+, Grade 2. The primary tumor was located predominantly in the left colon (155 pts; 68%), especially in the rectum (95 pts; 42%). Median OS-1 was 35.6 months (95% confidence interval [CI], 30.1-41.1 months), OS-2 was 16.5 months (95% CI, 13.9-19.1 months), and OS-3 was 2.0 months (95% CI, 1.5-2.5 months). Median time from first CRC diagnosis to BM was 29.2 months. Subsequent BM after extracranial metastasis were observed in 184 pts (80.7%), whereas 31 pts (13.6%) presented with solitary BM. Univariate analysis did not reveal a prognostic variable for overall survival after diagnosis of BM. CONCLUSION: This study presents the largest number of pts with mCRC and BM analyzed to date. The results show that most mCRC pts develop BM as a late step in the course of disease. Median time from first CRC diagnosis to BM is 29.2 months. Only a few pts were diagnosed with BM early in the disease or with solitary BM. When BM is present survival is poor.
Authors: Luis Del Carpio Huerta; Anna Cristina Virgili Manrique; Justyna Szafranska; Marta Martin-Richard; David Paez Lopez-Bravo; Ana Sebio Garcia; Iñigo Espinosa Mariscal; Paula Gomila Pons; Marta Andres Granyo; Andres Barba Joaquin; Agusti Barnadas Molins; Maria Tobeña Puyal Journal: Int J Colorectal Dis Date: 2018-06-25 Impact factor: 2.571
Authors: B Zhao; R A Gabriel; F Vaida; S Eisenstein; G T Schnickel; J K Sicklick; B M Clary Journal: Colorectal Dis Date: 2020-02-16 Impact factor: 3.788