P14.13 Clinical and pathologic features for survival in gastric cancer with brain metastasis

Abstract

Abstracts iii105 NEURO-ONCOLOGY • MAY 2017epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocation in 75 patients of lung cancer brain metastasis (LCBM) and molecular subtype of 33 patients of breast cancer brain metastasis (BCBM) at Seoul St. Mary's hospital between 2012 to 2016. RESULTS: The 50% of CCBM showed K-RAS mutation. The incidence of EGFR mutation and ALK translocation in LCBM were 34% and 16%, respectively. The proportions of luminal-A, luminal-B, Her-2 and triple negative subtypes of BCBM were 29%, 19%, 32% and 19%. The incidence of K-RAS mutation was higher (p=0.010) than primary colorectal cancer (32%). The incidence of EGFR mutation was equal, and the incidence of ALK translocation was significantly higher (p=0.011) than primary lung cancer (34% and 5%). And the proportions of Her-2 subtypes were significantly higher(p=0.000) and luminal-A subtypes was significantly lower (p=0.000) than primary breast cancer (10% and 62%). CONCLUSIONS: K-RAS mutation and ALK translocation elevates the metastatic potential of colorectal cancer and lung cancer, respectively. HER2-enriched breast cancer subtypes were associated with a significantly higher rate of brain metastasis. Luminal A subtypes was associated with a significantly lower rate of brain metastasis. This study sought to analyze the clinical features of gastric cancer and brain metastasis and prognostic factors for patient survival. MATERIALS AND METHODS: Fourteen cases of histologically confirmed advanced gastric cancer with brain metastases treated at our center between January 1996 and June 2015 were analyzed retrospectively. RESULTS: The median patient age was 64 years (range 51-75 years), and half of the patients had poorly differentiated adenocarcinoma. Human epidermal growth factor receptor 2 (HER-2) positivity by immunohistochemistry was observed in 5 patients. (35%) Ten patients had multiple brain lesions, and concurrent systemic metastases was found in 11 patients, commonly involving the liver. Twelve patients received steroids plus whole-brain radiation, and surgical resection of a single brain lesion was performed in 1 patient, who experienced a complete response. None of the patients received stereotactic radiosurgery (SRS). The median survival after the detection of brain metastases was 12 weeks (range, 2-48.4 weeks). Univariate analysis revealed that poor survival was associated with increased levels of serum lactate dehydrogenase (p= 0.005), unfavorable performance status (p= 0.021), and worsening neurological function after treatment for brain metastasis (p= 0.007). In multivariate analysis, worsening neurological function after treatment for brain lesions (hazard ratio 5.5, 95% confidence interval 1.49-20.5, p= 0.011) was confirmed as a significant prognostic factor for poor survival. CONCLUSIONS: Deterioration in neurological function after treatment for brain metastases was an unfavorable prognostic factor for patient survival. HER-2 overexpression seems to be associated with higher risk ...