Prognostic factors of colorectal cancer patients with brain metastases

Roussille, Pauline; Auvray, Marie; Vansteene, Damien; Lecomte, Thierry; Rigault, Eugénie; Maillet, Marianne; Locher, Christophe; Dior, Marie; Hautefeuille, Vincent; Artru, Pascal; Mabro, May; Touchefeu, Yann; Moulin, Valérie; Louafi, Samy; Lecaille, Cédric; Chautard, Romain; Lièvre, Astrid; Zaanan, Aziz; Bennouna, Jaafar; Berger, A.; Emambux, Sheik; Randrian, Violaine; Tougeron, David

doi:10.1016/j.radonc.2021.02.006

Cited by 10 publications

(16 citation statements)

References 24 publications

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“…Previous studies have explored factors associated with prognosis of CRC patients with BM, including extracranial metastases, number of BMs, and treatment of BM; 6 , 7 , 15 , 16 However, conclusions were varied among different studies. 17 The results of the current study showed that time of BMs, presence of extracranial metastases and treatment were significantly associated with OS in univariate analyses, however, only treatment was the independent factor in multivariate analyses for prognosis of CRC patients with BM.…”

Section: Discussionmentioning

confidence: 99%

“…11 Some surgeons recommend surgery combined with radiotherapy as it improves CRC patient survival better than surgery only, and others found no differences between the two treatments. [12][13][14] Prospective studies including more samples should be carried out to assess Previous studies have explored factors associated with prognosis of CRC patients with BM, including extracranial metastases, number of BMs, and treatment of BM; 6,7,15,16 However, conclusions were varied among different studies. 17 The results of the current study showed that time of BMs, presence of extracranial metastases and treatment were significantly associated with OS in univariate analyses, however, only treatment was the independent factor in multivariate analyses for prognosis of CRC patients with BM.…”

Section: Discussionmentioning

confidence: 99%

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Factors Prognostic for Brain Metastases from Colorectal Cancer: A Single-Center Experience in China

Wang

Chen

et al. 2021

CMAR

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Purpose This study aimed to analyze clinicopathological, survival, prognostic factors, as well as the timing of brain metastases (BM) in colorectal cancer (CRC) using data from a Chinese center. Patients and Methods Data of 65 consecutive CRC patients with BM were collected from a single institution in China. The time from primary tumor surgery to the occurrence of BM was calculated. Kaplan-Meier analysis was used to evaluate cumulative survival of patients. Factors associated with prognosis of overall survival (OS) were explored using Cox’s proportional hazard regression models. Results The median time interval from CRC surgery to the diagnosis of BM was 24 months. After diagnosis of BM, median OS values for patients were 11 months. Extracranial metastases occurred in 45 cases (69.2%) when BM was diagnosed, and 58.5% of these patients with lung metastases Time of BMs ( P =0.018), presence of extracranial metastases ( P =0.033), treatment ( P =0.003), CA199 ( P =0.034), CA125 ( P <0.001), CA242 ( P =0.018), and CA211 ( P =0.012) were associated with OS of patients through univariate analysis. Multivariate analysis using a Cox regression model showed that only treatment was an independent predictor for OS (conservative treatment; HR=1.861, 95% CI=1.077–3.441; P =0.048). Conclusion Surgical treatment of metastatic lesions may be an alternative choice for CRC patients with BM. Identifying the timing of brain metastases can help to detect this disease early, leading to a better survival outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors Prognostic for Brain Metastases from Colorectal Cancer: A Single-Center Experience in China

Wang

Chen

et al. 2021

CMAR

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“…This study was conducted on samples available from patients included in the study previously published by Roussille P et al. ( 2 , 3 ). All consecutive patients with BM from CRC, diagnosed from 2001 to 2016, were identified in our institution using our clinical report database.…”

Section: Methodsmentioning

confidence: 99%

“…In parallel to this OS improvement, the incidence of unusual metastatic sites such as brain metastases (BM) has increased ( 1 ). Mostly metachronous, BMs derived from CRC are diagnosed about two years after the primary tumor diagnosis and are usually associated with a RAS mutation ( 2 , 3 ). CRC-derived BMs remain associated with a poor prognosis with 5 months of median OS ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…This infiltration correlates with prolonged OS in BMs derived from lung cancer, breast cancer, melanoma or renal cell cancer ( 9 ). In CRC-derived BMs, data are lacking since BMs from CRC are rare (1 to 5% of CRC) ( 3 ). This is of great interest as prognosis in mCRC is correlated with infiltration of the least-immune infiltrated metastases and BMs are supposed to be poorly infiltrated by immune cells ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

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New Artificial Intelligence Score and Immune Infiltrates as Prognostic Factors in Colorectal Cancer With Brain Metastases

et al. 2021

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Incidence of brain metastases has increased in patients with colorectal cancer (CRC) as their survival has improved. CD3 T-cells and, lately, DGMate (DiGital tuMor pArameTErs) score, have been identified as prognostic factors in locally advanced CRC. Until now, there is no data concerning the prognostic value of these markers in patients with CRC-derived brain metastases. All consecutive patients with CRC-derived brain metastases diagnosed between 2000 and 2017 were retrospectively included. Staining for CD3, CD8, PD-1, PD-L1 and DGMate analyses were performed using tissue micro-array from primary tumors and, if available, brain metastases. All in all, 83 patients were included with 80 primary tumor samples and 37 brain metastases samples available. CD3 and CD8 T-cell infiltration was higher in primary tumors compared to brain metastases. We observed a significant higher DGMate score in rectal tumors compared to colon tumors (p=0.03). We also noted a trend of higher CD3 T-cell infiltration in primary tumors when brain metastases were both supra and subtentorial compared to brain metastases that were only subtentorial or supratentorial (p=0.36 and p=0.03, respectively). No correlation was found between CD3 or CD8 infiltration or DGMate score in primary tumors or brain metastases and overall survival (OS) in the overall population. In patients with rectal tumors, a high DGMate score in brain metastases was associated with longer OS (13.4 ± 6.1 months versus 6.1 ± 1.4 months, p=0.02). High CD3 T-cell infiltration in brain metastases was associated with lower OS in patients with supratentorial brain metastases (9.8 ± 3.3 months versus 16.7 ± 5.9 months, p=0.03). PD-L1 overexpression was rare, both in primary tumors and brain metastases, but PD-L1 positive primary tumors were associated with worse OS (p=0.01). In contrast to breast and lung cancer derived brain metastases, CD3 and CD8 infiltration and DGMate score are not major prognostic factors in patients with CRC-derived brain metastases.

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