Brain metastases in gastroesophageal cancers—an underestimated complication

Abstract

Background Brain metastases represent a severe complication in many gastrointestinal malignancies especially those arising from the upper gastrointestinal tract, including cancer of the esophagus, gastroesophageal junction, and stomach (GEC). However, there is little knowledge about the onset or potential risk factors for brain metastases (BRMs) in upper gastrointestinal cancers resulting in a lack of screening guidelines for BRMs. Methods We analyzed 827 patients from our cancer registry suffering from gastroesophageal cancer (GEC) and treated at the University Medical Center Göttingen between January 2013 and December 2019 for the presence of BRMs. Results From 827 patients with GEC we found 54 patients with BRMs, resulting in an incidence of 6.5%. BRMs are more frequent in male patients (90.74% vs 9.26%, p = 0.0051) and in adenocarcinomas (90.74% vs 9.26%, p = 0.0117). Mean duration for the onset of BRMs from initial cancer diagnoses was 20.9 months in limited disease (curative approach) and 9.3 months in advanced disease (palliative approach) (p = 0.0026). However, early detection of BRMs is a prognostic factor since patients with successful resection of BRMs have a better prognosis compared to those with unresectable BRMs (5.93 vs 2.07 months, p = 0.0091). Conclusion In this single-center retrospective study, brain metastases (BRMs) occur with a high frequency (6.5%) in gastroesophageal cancer (GEC), significantly more often in male patients and adenocarcinomas. Since survival of these patients considerably correlates with successful BRMs resection, our observations propose further prospective trails to validate our hypothesis and ultimately the implementation of routine screening procedures to detect asymptomatic brain metastases.

HER2-Positive Gastroesophageal Cancers Are Associated with a Higher Risk of Brain Metastasis

“…This is consistent with the findings of Hejlah, where seven of the nine resected patients who developed brain metastasis had nodal-positive disease at diagnosis (no patients in this study had metastatic disease at presentation). All bar one patient who developed brain metastasis were male in our study; brain metastasis are more common in male patients, and the rate of brain metastasis identification was similar to other GOCs cohorts [ 44 ].…”

Genomic alterations of cerebrospinal fluid cell-free DNA in leptomeningeal metastases of gastric cancer

“…In contrast, LM is relatively rare in gastric cancer (GC), with a frequency of only 0.16–0.69% [ 2 – 5 ]. Despite recent advances in systemic chemotherapy, the prognosis of gastric cancer patients with LM remained poor, with a median survival time of 4–6 weeks [ 6 ].…”

Brain-Only Metastasis and 10-Year Survival after Curative Gastric Cancer Resection: A Case Report

“…Recently, two retrospective studies by Harada et al [2] and Brunner et al [7] reported two common conditions and two common outcomes for isolated brain metastasis (BM) in GCs. First, the GC develops in the proximal portion of the gastroesophageal junction.…”

“…Third, the progression of BM was 14–20 months and the survival was better with isolated BM around 13–27 months after diagnosis of BM. Furthermore, Harada et al [2] showed that lymph node metastasis had a higher rate of BM, whereas Brunner et al [7] showed that male gender had a higher rate of BM. This case is similar in that the patient was a male with GC in the proximal area with adenocarcinoma type and had perigastric lymph node metastasis at the initial surgery.…”