Leptomeningeal Carcinomatosis and Brain Metastases in Gastroesophageal Carcinoma: a real-world analysis of Clinical and Pathologic Characteristics and Outcomes

Abstract

Background: Brain metastasis (BrM) and Leptomeningeal Carcinomatosis (LMC) are uncommon complications in gastroesophageal carcinoma (GEC) patients. These patients have a poor prognosis and are challenging to treat. We described the clinicopathologic features and outcomes in the largest cohort of Central Nervous System (CNS) metastasis in GEC patients. Methods: single-center retrospective study of GEC treated from 2007 to 2021. Clinicopathologic characteristics and treatment modalities were reviewed. Survival was calculated from the date of CNS diagnosis until date of death/last follow-up using the Kaplan-Meier method. A multivariable Cox proportional hazards regression model was used. Results: Of 3283 GEC patients, 100 (3.04%) were diagnosed with BrM and 20 with LMC (0.61%). Patients with known human epidermal growth factor receptor 2 (HER2) status (N= 48), 60% were HER2 positive (defined as IHC 3+ or IHC 2+/FISH+). Among LMC patients most were signet-ring subtype (85%), and only 15% (2/13) were HER2 positive. Median survival was 0.8; 3.8; and 7.7 months in BrM patients treated with best supportive care, radiation, and surgery, respectively (p< 0.001). In LMC, median survival was 0.7 month in patients who had best supportive care (7/20) and 2.8 months for those who had whole brain radiation therapy (p=0.008). Multivariate analysis showed worse outcomes in ECOG ≥2 (p=0.02), number of BrM ≥4 (p<0.001) and number of metastatic sites (p=0.004). Conclusion: HER2 expression were enriched in patients with BrM, while it is uncommon in LMC. Patients treated with surgery followed by radiation had an improved OS in BrM and WBRT benefited patients with LMC.