Survival Outcome of Surgical Resection vs. Radiotherapy in Brain Metastasis From Colorectal Cancer: A Meta-Analysis

Chang, Yu Tzu; Wong, Chia-En; Lee, Po-Hsuan; Huang, Chi-Chen; Lee, Jung-Shun

doi:10.3389/fmed.2022.768896

Cited by 6 publications

(16 citation statements)

References 44 publications

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“…The present data additionally reveal that time of BM diagnosis does not significantly impact patient survival measured from the day of BM resection. These results suggest that the intended prognostic benefit of a surgical therapy in these vulnerable patients [7,25] is present in both patients with metachronous and synchronous BM occurrence. Therefore, the authors recommend that surgical decision making in these patients with systemically spread cancer should be a process independent of the time of BM diagnosis.…”

Section: Discussionmentioning

confidence: 87%

Survival after resection of brain metastasis: impact of synchronous versus metachronous metastatic disease

et al. 2023

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Purpose Patients with brain metastasis (BM) from solid tumors are in an advanced stage of cancer. BM may occur during a known oncological disease (metachronous BM) or be the primary manifestation of previously unknown cancer (synchronous BM). The time of diagnosis might decisively impact patient prognosis and further treatment stratification. In the present study, we analyzed the prognostic impact of synchronous versus (vs.) metachronous BM occurrence following resection of BM. Methods Between 2013 and 2018, 353 patients had undergone surgical therapy for BM at the authors’ neuro-oncological center. Survival stratification calculated from the day of neurosurgical resection was performed for synchronous vs. metachronous BM diagnosis. Results Non-small-cell lung carcinoma (NSCLC) was the most common tumor entity of primary site (43%) followed by gastrointestinal cancer (14%) and breast cancer (13%). Synchronous BM occurrence was present in 116 of 353 patients (33%), metachronous BM occurrence was present in 237 of 353 patients (67%). NSCLC was significantly more often diagnosed via resection of the BM (56% synchronous vs. 44% metachronous situation, p = 0.0001). The median overall survival for patients with synchronous BM diagnosis was 12 months (95% confidence interval (CI) 7.5–16.5) compared to 13 months (95% CI 9.6–16.4) for patients with metachronous BM diagnosis (p = 0.97). Conclusions The present study indicates that time of BM diagnosis (synchronous vs. metachronous) does not significantly impact patient survival following surgical therapy of BM. These results suggest that the indication for neurosurgical BM resection should be made regardless of a synchronous or a metachronous time of BM occurrence.

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Section: Discussionmentioning

confidence: 87%

Survival after resection of brain metastasis: impact of synchronous versus metachronous metastatic disease

et al. 2023

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“…The lack of a significant link in our study is most likely because it only focused on synchronous BMs. But a recent meta-analysis revealed that the primary CRC site had little impact on the OS [ 12 ]. The effect of primary tumor location on the prognosis of patients with BMs of CRC needs further study.…”

Section: Discussionmentioning

confidence: 99%

“…Radiation, surgery, chemotherapy, or a combination of the three were the most prevalent treatments for BMs. Patients who had brain metastasectomy had a longer overall survival time than those who had radiotherapy [ 12 ]. Metastasectomy or multiagent chemotherapy has been linked to a higher overall survival rate [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…The prognosis of patients with BMs from CRC is very poor, as the median survival is only 2–9.6 months [ 6 , 7 , 8 ]. Age, Karnofsky performance status (KPS), extracerebral metastases, and BMs number are predictive variables for OS in retrospective investigations [ 9 , 10 , 11 , 12 ]. CRC BMs patients with negative CEA levels had a 3-month survival advantage, implying that a positive CEA level is related to a poor OS [ 6 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is based on criteria such as the patient’s performance status, the underlying tumor’s features, and the number/location of the brain lesions [ 15 ]. The goal of treatment is typically palliative, and alternatives include surgical excision, stereotactic radiosurgery (SRS), whole-brain radiation therapy (WBRT), or combinations of these [ 12 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Primary Tumor Resection Provides Survival Benefits for Patients with Synchronous Brain Metastases from Colorectal Cancer

Cheng

Chen

et al. 2022

Diagnostics

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Background: Brain metastases (BMs), particularly synchronous brain metastases, in colorectal cancer (CRC) patients are uncommon. The survival benefit of primary tumor resection (PTR) in patients with metastatic colorectal cancer is controversial. Whether PTR can bring survival benefits to patients with BMs of CRC has not been reported. Methods: From 2010 to 2016, 581 CRC patients with BMs from the Surveillance, Epidemiology, and End Results (SEER) database were divided into PTR and non-PTR groups. The log-rank test was used to compare the survival distributions. The Kaplan-Meier method was used to estimate survival. By controlling additional prognostic factors, a Cox proportional multivariate regression analysis was used to estimate the survival benefit of PTR. Results: The median overall survival for CRC patients with synchronous BMs was 3 months, with a 1-year survival rate of 27.2% and a 2-year survival rate of 12.8%. The PTR group contained 171 patients (29.4%), whereas the non-PTR group had 410 patients (70.6%). Patients who underwent PTR had a 1-year survival rate of 40.2% compared to 21.7% in those who did not (p < 0.0001). Cox proportional analysis showed that patients ≥60 years (hazard ratio [HR] 1.718, 95% confidence interval [CI] 1.423–2.075, p < 0.0001) had a shorter OS than patients < 60 years of age. OS was better in CEA-negative than in CEA-positive patients (HR 0.652, 95% CI 0.472–0.899, p = 0.009). Patients in whom the primary tumor was removed had considerably improved prognoses (HR 0.654, 95% CI 0.531–0.805, p < 0.0001). Subgroup analysis revealed that the PTR group achieved a survival advantage except for patients with CEA negative. Conclusions: Patients with synchronous BMs from CRC may benefit from primary tumor resection (PTR). Age, CEA level, and PTR were independent prognostic risk factors for CRC patients with synchronous BMs.

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Surgical excision and radiotherapy for brain metastasis from colorectal cancer: How frailty and comorbidity indices influence outcome

Wong,

Chang,

Huang

et al. 2024

The Kaohsiung J of Med Scie

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The incidence of brain metastasis (BM) from colorectal cancer (CRC) is increasing. This study aims to identify the clinical prognosticators and evaluate the prognostic validity of common comorbidity indices in patients with BM from CRC. This retrospective single‐center study analyzed 93 patients with BM from CRC who received surgical excision and/or radiotherapy. The clinical characteristics and prognostic indices including the 5‐item modified frailty index (mFI‐5) and prognostic nutritional index (PNI) were calculated from the collected patient data and analyzed. In this study, 66 (71.0%), 10 (10.8%), and 17 (18.3%) patients received whole‐brain radiotherapy (WBRT) alone, surgery alone, and surgery plus WBRT, respectively. The median survival of all patients was 3.98 months (IQR: 1.74–7.99). The 2‐ and 3‐year survival rates were 7.4% and 3.7%, respectively. Controlled primary tumor (p = 0.048), solitary BM (p = 0.001), surgery + radiation (p < 0.001), and greater PNI (p = 0.001) were independent predictors of favorable survival. In surgically treated patients, uncontrolled primary tumor (p = 0.006), presence of multiple BM (p < 0.001), and MFI‐5 ≥ 2 (p = 0.038) were independent prognosticators. For patients who received WBRT, the presence of two (p = 0.004) or multiple (p < 0.001) BM and PNI (p < 0.001) were independent survival predictors MFI‐5, multiple BM, and the status of the primary tumor were independent prognosticators for patients who underwent surgery for CRCBM. For patients who received WBRT, the PNI and the number of BM were independent survival predictors.

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Survival Outcome of Surgical Resection vs. Radiotherapy in Brain Metastasis From Colorectal Cancer: A Meta-Analysis

Cited by 6 publications

References 44 publications

Survival after resection of brain metastasis: impact of synchronous versus metachronous metastatic disease

Survival after resection of brain metastasis: impact of synchronous versus metachronous metastatic disease

Primary Tumor Resection Provides Survival Benefits for Patients with Synchronous Brain Metastases from Colorectal Cancer

Surgical excision and radiotherapy for brain metastasis from colorectal cancer: How frailty and comorbidity indices influence outcome

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