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 0.7; 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 (7/19) and 2.8 months for those who had whole brain radiation therapy (p = 0.015). Multivariate analysis showed worse outcomes in ECOG ≥ 2 (p = 0.002), number of BrM ≥ 4 (p < 0.001) and number of metastatic sites (p = 0.009).

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.

中文翻译：

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胃食管癌的软脑膜癌病和脑转移：临床和病理特征及结果的真实分析

背景

脑转移 (BrM) 和软脑膜癌 (LMC) 是胃食管癌 (GEC) 患者中罕见的并发症。这些患者预后不良，治疗具有挑战性。我们描述了最大的 GEC 患者中枢神经系统 (CNS) 转移队列的临床病理特征和结果。

方法

2007年至2021年治疗GEC的单中心回顾性研究。回顾了临床病理特征和治疗方式。使用 Kaplan-Meier 方法计算从 CNS 诊断日期到死亡/最后一次随访日期的生存期。使用多变量 Cox 比例风险回归模型。

结果

在 3283 名 GEC 患者中，100 名（3.04%）被诊断为 BrM，20 名被诊断为 LMC（0.61%）。已知人类表皮生长因子受体 2 (HER2) 状态的患者 ( N  = 48)，60% 为 HER2 阳性（定义为 IHC 3 + 或 IHC 2+/FISH+）。在LMC患者中，大多数为印戒亚型（85%），只有15%（2/13）为HER2阳性。中位生存率为 0.7； 3.8；接受最佳支持治疗、放疗和手术治疗的 BrM 患者分别为 7.7 个月和 7.7 个月 ( p  < 0.001)。在 LMC 中，接受最佳支持治疗的患者的中位生存期为 0.7 个月 (7/19)，接受全脑放射治疗的患者的中位生存期为 2.8 个月 ( p  = 0.015)。多变量分析显示，ECOG ≥ 2 ( p  = 0.002)、BrM 数量 ≥ 4 ( p  < 0.001) 和转移部位数量 ( p  = 0.009) 的结果较差。

结论

HER2 表达在 BrM 患者中丰富，而在 LMC 中不常见。接受手术后放疗的患者 BrM 的 OS 有所改善，并且 WBRT 使 LMC 患者受益。