Brain metastases in patients with upper gastrointestinal cancer is associated with proximally located adenocarcinoma and lymph node metastases

Kazuto Harada, Hyunsoo Hwang, Xuemei Wang, Ahmed Abdelhakeem, Masaaki Iwatsuki, Mariela A.Blum Murphy, Dipen M. Maru, Brian Weston, Jeffrey H. Lee, Jane E. Rogers, Allison Trail, Namita Shanbhag, Meina Zhao, Manoop S. Bhutani, Quynh Nhu Nguyen, Stephen G. Swisher, Naruhiko Ikoma, Prajnan Das, Wayne L. Hofstetter, Brian D. BadgwellJaffer A. Ajani

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background: As cancer patients are surviving longer, more patients manifest brain metastases (BRMs). However, the rate of BRMs from upper gastrointestinal cancer is unclear. We therefore evaluated the frequency and prognostic effect of BRMs in this setting. Methods: We analyzed records of 2348 patients who were treated between January 2002 and December 2016 for upper gastrointestinal cancer, including esophageal and gastroesophageal junction adenocarcinoma (EAC; proximal EAC, Siewert types I and II), esophageal squamous cell carcinoma (ESCC), and gastric adenocarcinoma (GAC; Siewert type III and stomach cancer) in our Gastrointestinal Medical Oncology Database. Frequency, risk factors, and survival after BRMs were evaluated. Results: Of 2348 patients, 68 (2.9%) had BRMs upon follow-up. The BRM rates were as follows: proximal EAC, 4.8%; Siewert type I, 5.9%; Siewert type II, 2.2%; Siewert type III, 0.7%; ESCC: 1.2%; and stomach cancer, 0%. Among EAC patients, Siewert type I and lymph node metastases were independent the risk factors for BRMs in the multivariable analysis. The median overall survival (OS) in the 68 patients with BRMs was only 1.16 years (95% CI 0.78–1.61). However, OS for patients who had a solitary BRM, who had BRM but no other distant metastasis, or who underwent surgery or stereotactic radiosurgery favorable. Conclusion: Patients with proximally located adenocarcinoma, or with lymph node metastases are at a higher risk for BRMs and patients fare better after treatment of isolated BRM.

Original languageEnglish (US)
Pages (from-to)904-912
Number of pages9
JournalGastric Cancer
Volume23
Issue number5
DOIs
StatePublished - Sep 1 2020

Keywords

  • Brain metastases
  • Esophageal adenocarcinoma
  • Esophageal squamous-cell carcinoma
  • Gastric adenocarcinoma
  • Gastroesophageal junction adenocarcinoma

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

MD Anderson CCSG core facilities

  • Biostatistics Resource Group

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