Brain metastasis from colorectal cancer: clinical characteristics,timing, survival and prognostic factors

Abstract

Background: Brain metastasis (BM) from colorectal cancer (CRC) seriously affects the survival and quality of life of patients. However, this disease is not fully understood. It is not clear when follow-up monitoring should be conducted to achieve early diagnosis. Furthermore, the reported prognostic factors have varied among different studies. Our study aims to determine the clinicopathological, survival and prognostic factors, as well as the timing of BM occurrence.

Methods: We retrospectively studied the patients with BM from CRC between January 2000 and July 2017. The clinicopathologic features were assessed, and the time from primary tumor surgery and extracranial metastases (lung, liver and bone) to the occurrence of BM was calculated, respectively. Survival time after BM was statistically analyzed. Multivariate Cox analysis was carried out to determine the independent factors that affected survival.

Results: 52 patients were analyzed. Most of the patients (86.5%) had combined extracranial metastases when BM was diagnosed, and lung was the commonest extracranial metastasis location. The median time interval from CRC surgery to the diagnosis of BM was 20.5?months, and the median time interval from lung, liver and bone metastases to BM was 7, 5 and 2?months, respectively. After diagnosis of BM, the median survival was 9?months. Extracranial metastases (p?=.012) and Karnofsky performance status (p?=.025) were independent prognostic factors based on multivariate analysis.

Conclusion: BM from colorectal cancer often occur in the late stage, and has an extremely poor prognosis. Identifying the timing of brain metastasis can help to detect this disease early.     

Prognostic factors following liver resection for hepatic metastases from colorectal cancer

AIM: To determine the impact of prognostic factors on survival of patients with metastases from colorectal cancer that underwent liver resection. METHODS: The records of 28 patients that underwent liver resection for metastases from colorectal cancer between April 1992 and September 2001 were retrospectively analyzed. Thirty-eight resections were performed (more than one resection in eight patients and two patients underwent re-resections). The primary tumor was resected in all the patients. A screening protocol for liver metastases including clinical examinations every three months, ultrassonography and CEA level until 5 years of follow-up and after every 6 months, was applied. The prognostic factors analyzed regarding the impact on survival were: Dukes C stage of primary tumor, size of metastasis >5 cm, a disease-free interval from primary tumor to metastasis < 1 year, CEA level > 100 ng/mL, resection margins < 1 cm and extrahepatic disease. The Kaplan-Meier curves, log rank and Cox regression were used for the statistical analysis. RESULTS: Perioperative morbidity and mortality were 39.3% and 3.6%, respectively. The 5-year survival rate was 35%. The independent prognostic factors were: disease-free interval from primary tumor to metastasis < 1 year and extrahepatic disease. CONCLUSIONS: The liver resection for metastases from colorectal cancer is a safe procedure with more than 30% 5-year survival. Disease-free interval from primary tumor to metastasis < 1 year and extrahepatic disease were independent prognostic factors.     

Patients with brain metastases from gastrointestinal tract cancer treated with whole brain radiation therapy： Prognostic factors and survival

AIM: To identify the prognostic factors with regard to survival for patients with brain metastasis from primary tumors of the gastrointestinal tract. METHODS: Nine hundred and sixteen patients with brain metastases, treated with whole brain radiation therapy (WBRT) between January 1985 and December 2000 at the Department of Radiation Oncology, University Hospital Freiburg, were analyzed retrospectively. RESULTS: Fifty-seven patients presented with a primary tumor of the gastrointestinal tract (esophagus: n=0, stomach: n=10, colorectal: n=47). Twenty-six patients had a solitary brain metastasis, 31 patients presented with multiple brain metastases. Surgical resection was performed in 25 patients. WBRT was applied with daily fractions of 2 Gray (Gy) or 3Gy to a total dose of 50Gy or 30Gy, respectively. The interval between diagnoses of the primary tumors and brain metastases was 22.6mo vs 8.0mo for patients with primary tumors of the colon/rectum vs other primary tumors, respectively (P&lt;0.01, log-rank). Median overall survival for all patients with brain metastases (n=916) was 3.4mo and 3.2mo for patients with gastrointestinal neoplasms. Patients with gastrointestinal primary tumors presented significantly more often with a solitary brain metastasis than patients with other primary tumors (P&lt;0.05, log-rank). In patients with gastrointestinal neoplasms (n=57), the median overall survival was 5.8 mo for patients with solitary brain metastasis vs 2.7mo for patients with multiple brain metastases (P&lt;0.01, log-rank). The median overall survival for patients with a Karnofsky performance status (KPS) ≥70 was 5.5mo vs 2.1mo for patients with KPS &lt;70 (P&lt;0.01, log-rank). At multivariate analysis (Cox Model) the performance status and the number of brain metastases were identified as independent prognostic factors for overall survival. CONCLUSION: Brain metastases occur late in the course of gastrointestinal tumors. Pretherapeutic variables like KPS and the number of brain metastases have a profound influence on treatment outcome.     

Prognosis of HER2 over-expressing gastric cancer patients with liver metastasis

AIM: To study the risk factors for liver metastasis and the prognosis in patients with human epidermal growth factor receptor 2 (HER2) over-expressing gastric cancer (GC).METHODS: A total of 84 GC patients recruited from the General Hospital of the People’s Liberation Army (PLA) between 2003 and 2010 were randomly enrolled in this study. HER2 expression was detected by immunohistochemistry in 84 GC patients with liver metastases. The study group consisted of 66 men and 18 women, with an average age of 54 years (range: 19-74 years). Liver metastasis was diagnosed by magnetic resonance imaging or computed tomography. Patients were followed-up and predictive factors of liver metastasis were evaluated.RESULTS: The median follow-up period was 47 mo (range: 6-85 mo). The characteristics of 35 (25.7%) patients with HER2 over-expression of liver metastatic GC are presented. HER2 over-expression was detected in 23 out of 49 (46.9%) patients with intestinal GC, and 9 out of 35 (25.7%) patients with diffuse GC. 29 out of 59 (49.2%) patients aged < 60 years were HER2-positive, while 8 out of 25 (32%) patients aged ≥ 60 were HER2-positive; a significant difference (P < 0.05). Univariate analysis (log-rank test) showed that HER2 over-expression, sex, Lauren classification, differentiation and disease-free interval were correlated with poor survival (P < 0.05). Survival analysis with a survival curve showed that HER2 over-expression was significantly relevant, with a reduced survival time in GC patients with liver metastases (P < 0.01). 2-year survival was not associated with the patient’s age. A disease-free survival longer than 12 mo has a significant association with extended overall survival (OS) in GC patients with liver metastases. The median survival time after the diagnosis of liver metastases was 18 mo [95% confidence interval (CI): 9.07-26.94] among HER2 positive GC patients with liver metastases. In comparison, for 49 (69.4%) out of 84 HER2 negative patients with liver metastatic GC, the median survival time was 47 mo (95% CI: 19.37-74.63). In patients with HER2 positive liver metastatic GC, the median OS was significantly shorter than in HER2 negative patients (median, 20.32 mo; 95% CI: 16.51-24.13 vs median, 50.14 mo; 95% CI: 37.83-62.45; P < 0.01).CONCLUSION: HER2 over-expressing GC patients with liver metastases have a poor prognosis. Overall survival was significantly lower in HER2 positive patients. HER2-overexpression is correlated with a lower survival rate.     

Long-term results and prognostic factors after resection of hepatic and pulmonary metastases of colorectal cancer

Background

Resection of colorectal liver or lung metastases is an established therapeutical concept at present. However, an affection of both these organs is frequently still regarded as incurable.

Methods

All cancer patients are documented in our prospective cancer registry since 1995. Data of patients who underwent liver and lung resection for colorectal metastases were extracted and analysed.

Results

Sixty-five patients underwent surgery for liver and lung metastases. In 33 cases, the first distant metastasis was diagnosed synchronously to the primary tumour. For the remaining patients, median time interval between primary tumour and first distant metastasis was 18 months (5–69 months). Complete resection was achieved in 51 patients (79 %) and was less likely in patients with synchronous disease (p?=?0.017). Negative margins (p?=?0.002), the absence of pulmonary involvement in synchronous metastases (p?=?0.0003) and single metastases in both organs (p?=?0.036) were associated with a better prognosis. Five- and 10-year survival rates for all patients are 57 and 15 % from diagnosis of the primary tumour, 37 and 14 % from resection of the first metastasis and 20 and 15 % from resection of the second metastasis. After complete resection, 5- and 10-year survival rates increased to 61 and 18 %, 43 and 17 % as well as 25 and 19 %, respectively. Long-term survivors (≥10 years) were seen only after complete resection of both metastases.

Conclusions

Patients with resectable liver and lung metastases of the colorectal primary should be considered for surgery after multidisciplinary evaluation regardless of the number or size of the metastases or the disease-free intervals. Clear resection margins are the strongest prognostic parameter.     

Pulmonary resection of metastatic colorectal adenocarcinoma. A ten year experience

During a ten-year period, 66 patients with known primary colorectal adenocarcinoma underwent thoracotomy for pulmonary metastases. The median post-thoracotomy survival was 3.5 years and the cumulative survival at five years was 38 percent. The number of pulmonary metastases was significantly associated with post-thoracotomy survival (p less than .001). Patients with a solitary metastasis had a better survival than those with multiple pulmonary metastases. The association of disease-free interval and post-thoracotomy survival was of borderline significance (p = 0.1). Age, sex, grade of tumor, location of primary cancer, location of pulmonary metastases, size of resected metastases, initial stage of the primary colorectal cancer and the type of pulmonary resection had no influence on post-thoracotomy survival.     

Pulmonary resection for metastases from colorectal cancer

BACKGROUND: We reviewed our experience in the surgical treatment of 47 patients with colorectal pulmonary metastases and investigated factors affecting their survival. METHOD: From September 1986 to December 1999, 47 patients underwent 59 thoracotomies for pulmonary metastases from colorectal cancer. RESULTS: The median interval between colorectal resection and lung resection (disease-free interval [DFI]) was 33 months. Overall, 5-year survival was 48%. Five-year survival was 51% for patients with solitary metastasis (n = 30), 47% for patients with ipsilateral multiple metastases (n = 11), and 50% for patients with bilateral metastases (n = 6), and there were no significant differences. Five-year survival was 80.8% for 14 patients with DFI of < 2 years and 39.7% for 30 patients with a DFI of > 2 years (p = 0.22). Five-year survival for 11 patients with normal prethoracotomy carcinoembryonic antigen (CEA) levels was 70%, and that for 26 patients with elevated prethoracotomy CEA levels (> 5 ng/mL) was 36% (p < 0.05). Eight patients had extrathoracic disease. The median survival time after pulmonary resection was 18.5 months, and the 5-year survival was 60%. A second resection for recurrent metastases was performed in five patients, and a third resection was done in one patient. All six patients are alive. The median survival of five patients who underwent a second thoracotomy was 22 months (range, 2 to 68 months), and one patient is alive 39 months after the third resection. CONCLUSION: Pulmonary resection for metastases from colorectal cancer may help prolong survival in selected patients, even with bilateral lesions, recurrent metastasectomy, or extrathoracic disease. Prethoracotomy CEA level was found to be a significant prognostic factor.     

Contemporary operative management of pulmonary metastases of colorectal origin

The management of patients with metastatic disease from primary carcinoma of the colon and rectum is still controversial. To evaluate the results of resection of pulmonary metastases from patients with colorectal primaries, a retrospective study of all patients who underwent such resection was carried out at the teaching hospitals of McGill University and Université de Montréal. A total of 345 patients admitted with pulmonary metastases; 27 of them underwent pulmonary resection with the extent of the resection varying from wedge excision of the metastatic nodule to pneumonectomy. In 25 of the 27 patients the resection was considered curative. Eight of the 27 patients had resection of two metastatic lesions while the remaining 19 patients had resection of solitary lesions. The interval between resection of the primary colorectal malignancy and the resection of the metastatic lesion (disease-free interval) varied from 2 to 77 months with a median interval of 35 months. The five-year survival following resection of pulmonary metastases was 21 percent. A prolonged interval between treatment of the primary and resection of the pulmonary metastasis was associated with a longer survival. This retrospective study demonstrates that prolonged survival can be achieved following resection of pulmonary metastases from colorectal carcinoma. Read at the meeting of the American Society of Colon and Rectal Surgeons, Washington, D.C., April 5 to 10, 1987.     

胰腺转移癌10例诊断及治疗

目的 探讨胰腺转移癌的诊断及治疗方法.方法 对1997年7月至2007年7月中国医科大学附属第一医院收治的10例胰腺转移癌进行回顾性分析.结果 原发肿瘤为肺癌3例、结肠癌2例、胃癌2例、肾癌2例、鼻咽癌1例.胰腺转移距发现原发肿瘤时间间隔平均40个月(0-192个月).10例转移灶均位于胰腺头颈部,单发9例,多发1例,肿瘤最大径平均3.03cm.主要临床表现为腹痛、腹胀、厌食、黄疸等.行胰十二指肠切除术2例.胰动脉灌注化疗1例,经皮经肝胆管内支架置入术1例,全身化疗2例.放疗1例,3例未行进一步治疗.7例获得随访,生存时间2-44个月,平均10.6个月.结论 胰腺转移癌临床少见,表现无特异性,应根据具体情况选择合理的治疗措施,对可切除者应积极手术治疗.     

结直肠癌肺转移患者的临床回顾性分析

目的 了解结直肠癌肺转移患者的生存时间(OS)和结直肠癌根治术后发生肺转移的时间间隔并寻找相关影响因素.方法 对206例结直肠癌肺转移患者的各项临床参数、治疗方法、无转移间隔时间(DFI)和OS进行分析.结果 结直肠癌肺转移患者6个月、1年、2年、3年和5年的累积生存率分别为79%、46%、25%、20%和18%,中位OS为16个月.有或无特异性肺部及相关症状、性别、年龄、伴或不伴肝转移、肺转移灶单发或多发、是否存在纵隔和(或)肺门淋巴结转移均与OS无关(P值均＞0.05).单因素分析发现结直肠癌原发部位(P=0.020)、脉管浸润(P=0.022)和T分期(P=0.009)是影响肺转移患者中位OS的因素,但多因素分析未发现独立预后因子.接受肺转移灶切除术者相比单纯化学治疗者中位OS更长(分别为34和16个月),但因例数较少,差异尚无统计学意义(P=0.125).160例接受结直肠癌根治术者中,术后第1年和第2年各有48例患者出现肺转移,中位DFI为20个月.DFI与结直肠癌原发部位、形态类型、分化程度、T分期和N分期相关(P值均＜0.05),其中T分期是DFI的独立预测因子(P=0.023).结论 结直肠癌肺转移多发生在结直肠癌根治术后2年内,DFI、临床特征、病理特征和分期均不是独立的生存预后指标,但T分期是影响DFI的独立预测因子.     

A multicentre study of primary breast diffuse large B‐cell lymphoma in the rituximab era

Primary breast diffuse large B‐cell lymphoma (DLBCL) is a rare subtype of non‐Hodgkin lymphoma (NHL) with limited data on pathology and outcome. A multicentre retrospective study was undertaken to determine prognostic factors and the incidence of central nervous system (CNS) relapses. Data was retrospectively collected on patients from 8 US academic centres. Only patients with stage I/II disease (involvement of breast and localized lymph nodes) were included. Histologies apart from primary DLBCL were excluded. Between 1992 and 2012, 76 patients met the eligibility criteria. Most patients (86%) received chemotherapy, and 69% received immunochemotherapy with rituximab; 65% received radiation therapy and 9% received prophylactic CNS chemotherapy. After a median follow‐up of 4·5 years (range 0·6–20·6 years), the Kaplan–Meier estimated median progression‐free survival was 10·4 years (95% confidence interval [CI] 5·8–14·9 years), and the median overall survival was 14·6 years (95% CI 10·2–19 years). Twelve patients (16%) had CNS relapse. A low stage‐modified International Prognostic Index (IPI) was associated with longer overall survival. Rituximab use was not associated with a survival advantage. Primary breast DLBCL has a high rate of CNS relapse. The stage‐modified IPI score is associated with survival.     

Metastasis to the thyroid diagnosed by fine-needle aspiration biopsy

BACKGROUND: Metastasis to the thyroid is uncommon, but the number of cases seems to have increased in recent years. This increase may be related to more frequent use of fine-needle aspiration biopsy (FNAB) in any suspected case. DESIGN: A retrospective review of patients with thyroid metastasis diagnosed by FNAB at the Asan Medical Centre. PATIENTS: Twenty-two patients who were seen at the Asan Medical Centre between 1997 and 2003. Median age was 55 years with range between 34 and 74 years. RESULTS: Fourteen patients presented with a palpable thyroid nodule. Eight patients had an impalpable thyroid nodule that was found incidentally during the various imaging studies. The breast (five patients) was the most common primary site followed by the kidney (three), colon (three) and lung (three). FNAB confirmed metastatic disease in 19 patients and raised suspicion in three patients. The suspicion of metastasis to the thyroid was confirmed by Tru-cut needle core biopsy in one patient and surgery in two patients. Thyroid metastases were found during the initial work-up for primary tumour in eight patients. In the remaining 14 patients, the interval from diagnosis of primary tumour to the detection of thyroid metastasis varied from 8 months to 15 years, with a median of 54 months. Fifteen patients had metastatic disease elsewhere at the time of presentation. Ten patients received chemotherapy. Radiotherapy was used in two patients. Seven patients are still alive, with one patient disease free for 16 months following resection of the thyroid metastasis. CONCLUSIONS: Thyroid metastases are uncommon but can be detected more frequently with routine use of FNAB. Breast cancer is the most common tumour that metastasizes to the thyroid. They usually occur when there are metastases elsewhere, sometimes many years after the diagnosis of the original primary tumour and show poor prognosis in general.     

Cutaneous metastasis of cholangiocarcinoma

AIM:To investigate the clinical characteristics and prognostic factors of cutaneous metastasis of cholangiocarcinoma by a retrospective analysis of published cases.METHODS:An extensive search was conducted in the English literature within the Pub Med database using the following keywords:cutaneous metastasis or skin metastasis and cholangiocarcinoma or bile duct.The data of 30 patients from 21 articles from 1978 to 2014 were analyzed.Patient data retrieved from the articles included the following:age,gender,time cutaneous metastasis occurred,number of cutaneous metastases throughout life,sites of initial cutaneous metastasis,anatomic site,pathology and differentiation of cholangiocarcinoma,and immunohistochemical results of the cutaneous metastasis.The assessment of overall survival after cutaneous metastasis(OSCM) was the primary endpoint.RESULTS:The median age at diagnosis of cutaneous metastasis of cholangiocarcinoma was 60.0 years(range:35-77).This metastasis showed a predilection towards males,with a male to female ratio of 3.29.In 8 cases(27.6%),skin metastasis was the first sign of cholangiocarcinoma.Additionally,18 cases(60.0%) manifested single cutaneous metastasis,while 12 cases(40.0%) demonstrated multiple skin metastases.In 50.0% of patients,the metastasis occurred in the drainage region,while 50.0% of patients had distant cutaneous metastases.The scalp was the most frequently involved region of distant skin metastasis,occurring in 36.7% of patients.The median OSCM of cholangiocarcinoma was 4.0 mo.Patient age and cutaneous metastatic sites showed no significant relation with OSCM,while male gender and single metastasis of the skin were associated with a poorer OSCM(hazard ratio:0.168;P = 0.005,and hazard ratio:0.296;P = 0.011,respectively).CONCLUSION:The prognosis of cutaneous metastasis of cholangiocarcinoma is dismal.Both male gender and single skin metastasis are associated with a poorer OSCM.     

Bone metastases from hepatocellular carcinoma:clinical features and prognostic factors

BACKGROUND: Bone metastases (BMs) from hepatocellu-lar carcinoma (HCC) is an increasingly common disease in Asia. We assessed the clinical features, prognostic factors, and differences in outcomes related to BMs among patients with different treatments for HCC. METHODS: Forty-three consecutive patients who were diag-nosed with BMs from HCC between January 2010 and Decem-ber 2014 were retrospectively enrolled. The clinical features were identified, the impacts of prognostic factors on survival were statistically analyzed, and clinical data were compared. RESULTS: The median patient age was 54 years; 38 patients were male and 5 female. The most common site for BMs was the trunk (69.3%). BMs with extension to the soft tissue were found in 14 patients (32.5%). Most (90.7%) of the lesions were mixed osteolytic and osteoblastic, and most (69.8%) patients presented with multiple BMs. The median survival after BMs diagnosis was 11 months. In multivariate analyses, survival after BM diagnosis was correlated with Karnofsky perfor-mance status (P=0.008) and the Child-Pugh classification (P<0.001); BM-free survival was correlated with progression beyond the University of California San Francisco criteria (P<0.001) and treatment of primary tumors (P<0.001). BMs with extension to soft tissue were less common in liver trans-plantation patients. During metastasis, the control of intrahe-patic tumors was improved in liver transplantation and hepa-tectomy patients, compared to conservatively treated patients. CONCLUSIONS: The independent prognostic factors of surviv-al after diagnosis of BMs were the Karnofsky performance status and Child-Pugh classification. HCC patients developed BMs may also benefit from liver transplantation or hepatectomy.     

26例胃肠道间质瘤肝转移的临床特征和生存分析

目的 总结胃肠道间质瘤肝转移的临床病理特征，行生存分析，对诊断和治疗原则进行探讨。方法 收集本院收治的资料完整的胃肠道间质瘤患者99例，对其中26例肝转移患者的临床病理特征进行回顺性分析，探讨肝转移发生后生存时间的影响因素。结果 原发肿瘤和发生肝转移的平均年龄为50．8和51．8岁。病理证实者5例，手术中探查诊断为肝转移者12例，14例为单纯影像学诊断。发现原发肿瘤的同时和非同时伴肝转移者分别为8例和18例，非同时发现者肝转移距原发肿瘤手术时间的中位时间为12个月。肿瘤原发于胃12例．结直肠5例，小肠6例，胃肠道外3例。肝转移灶切除者4例，无水乙醇注射2例，介入治疗3例，全身静脉化疗7例，伊马替尼（格列卫）治疗8例，未治疗2例。肝转移后中位生存时间为21个月。伊马替尼治疗为影响肝转移后生存时间的重要因素。结论 原发部位为胃的胃肠道间质瘤肝转移最常见；小肠问质瘤易发生肝转移；服用伊马替尼3个月以上可延长生存。     

Clinicopathological features and outcome of hepatic resection for liver metastasis from gastric cancer

BACKGROUND/AIMS: The efficacy of operative resection of lesions metastatic to the liver from colorectal or neuroendocrine tumor is well established. However, the appropriate management of liver metastasis from gastric cancer is controversial. We analyzed the prognostic factors in patients who underwent hepatectomy for metastasis from gastric cancer. METHODOLOGY: Retrospective clinical and pathological study in Tokyo Metropolitan Bokutoh Hospital. Ten patients underwent hepatectomy for metastases from gastric cancer out of 1807 patients with gastric cancer between 1981 and 1998. INTERVENTIONS: Clinical investigation and histopathological examination of resected specimen. MAIN OUTCOME MEASURES: Survival, recurrence, liver metastases and lymph node metastases. RESULTS: The 1-, 3-, and 5-year survival rates of these ten patients were 50%, 30%, 20%, respectively. The median survival time was 25 months, and two patients survived longer than five years. The survival time tended to be longer, but not to a significant extent, in patients with no lymph nodal involvement at the primary site (P = 0.067). CONCLUSIONS: Even though it is rare, a survival time of 5-years can be achieved by resection of gastric cancer metastatic to the liver. These results suggest that a patient with liver metastasis from gastric cancer has a greater chance of surviving long-term if there is no lymph node metastasis at the primary site.     

Cutaneous metastasis as a initial presentation in advanced non-small cell lung cancer and its poor survival prognosis

Aim

Cutaneous metastases in primary advanced non-small cell lung cancer (NSCLC) rarely occur in comparison with other site involvement. The incidence of cutaneous metastases and its prognosis is not well known. Data from a 2,130 patients with advanced NSCLC were analyzed, in order to assess the incidence and survival prognosis of cutaneous metastases in primary advanced NSCLC.

Methods

The clinical data of 2,130 patients with advanced NSCLC who were admitted to Zhejiang cancer Hospital from January 1998 to December 2007 were retrospectively analyzed. Data pertaining to their presentation, diagnosis treatment, pathology, follow–up, and clinical course were documented. Clinical characteristics were investigated based on the clinical and pathologic records. All of the cutaneous metastases were confirmed by cytology or biopsy. Survival analysis was made by Kaplan–Meier method. The Cox regression model was performed to analyze the relationship between the influential factors and the overall survival.

Results

Among the 2,130 advanced NSCLC patients as initial diagnosis, 60 (2.8?%) demonstrated abnormally cutaneous metastases. Fifteen patients with only cutaneous metastases, forty-five subjects combined with other site metastasis. There were 56 patients who received chemotherapy, and the first-line disease control rate was 33.9?%, the median free progression survival time was 1.9?months. There were significant differences in overall survival between cutaneous metastases and non-cutaneous metastases arms (3.9 vs. 10.0?months, P?Conclusions This retrospective study indicated that 2.8?% of advanced NSCLC patients showed cutaneous metastases as an initial presentation. Cutaneous metastases of lung cancer are of poor prognosis.     

Brain metastases as the first symptom of lung cancer: a clinical study from an Asian medical center

Objective

Brain metastasis as the first symptom of lung cancer is a unique clinical entity. We conducted a retrospective study to investigate the clinical characteristics and survival of patients with lung cancer whose first symptom was brain metastases in an Asian population.

Methods

A retrospective study of 186 such patients who had been admitted to one institution in China between January 1, 2003 and December 30, 2008 was performed. The following data were collected and analyzed: manifesting signs and symptoms, imaging studies, extracerebral metastases, initial diagnosis, treatment, and patient survival.

Results

This sample population exhibited high rates of misdiagnosis upon initial presentation (46.8 %). Fifty-seven (30.6 %) patients presented with silent extracerebral metastases. Pathologies among this cohort varied, and adenocarcinomas were most commonly observed. Most patients received surgical resection, and some patients had additional whole-brain radiotherapy or stereotactic radiosurgery. The median survival time for the entire cohort was 15 months (95 % confidence interval, 12.9–17.1 months). Survival rates for 1, 2, and 5 years were 58.2, 34.2, and 6.5 %, respectively. The median survival time was 15, 14, 19, and 7 months for the gross total resection, incomplete resection, surgery + whole-brain radiotherapy, and surgery + stereotactic radiosurgery groups, respectively.

Conclusions

Brain metastasis as the first symptom of lung cancer is a distinct clinical entity. Although overall survival was poor, combined treatments based on surgery for selected patients were reasonable with the exception of a minority who experienced long-term survival.     

Pulmonary resection for metastases from colorectal cancer: prognostic factors and survival

Backgrounds Pulmonary metastases occur in up to 10% of all patients who undergo curative resection. Surgical resection is an important part in the treatment of pulmonary metastasis from colorectal cancer. We analyzed the treatment outcome and prognostic factors affecting survival in this subset of patients. Materials and methods Between October 1994 and December 2004, 59 patients underwent curative resection for pulmonary metastases of colorectal cancer. Uncontrollable synchronous liver and lung metastasis or synchronous colorectal cancer with isolated lung metastasis were excluded from this study. A retrospective review of patient characteristics and factors influencing survival was performed. Survival was analyzed by the Kaplan–Meier method. Comparison between groups were performed by a log-rank analysis and the Cox proportional hazard model. Results The 5-year overall survival rate of all patients who received pulmonary resection was 50.3%. The number of pulmonary metastases was significantly related with survival in univariate analysis, but not in multivariate analysis (p = 0.032). Prethoracotomy carcinoembryonic antigen (CEA) level exceeding 5 ng/ml was related with poor survival (p = 0.001). A disease-free interval of greater than 2 years did not correlate with survival after thoracotomy (p = 0.3). Conclusion The prethoracotomy CEA level and the number of metastases were independent prognostic factors. Resection of pulmonary metastasis from colorectal cancer may result in improved survival or even healing in selected patients. Pulmonary resection of colorectal cancer is regarded as a safe and effective treatment with low morbidity and mortality rates.     

Characteristic differences between patients who have undergone surgical treatment for lung metastasis or hepatic metastasis from colorectal cancer

OBJECTIVE: The characteristic differences between patients with lung or liver metastases from colorectal carcinoma (CRC) have not yet been clarified. A small group of these patients demonstrate a better prognosis, and the selection criteria for resection of liver and/or lung metastasis are not well defined. It is important to compare and analyze the most common metastatic sites, which include liver metastases and lung metastases. The objective of this study was to compare the characteristics of the two groups in order to identify patients who benefitted from surgical resection of CRC. METHODS: We retrospectively reviewed the medical charts of 80 patients who had undergone resection for liver or lung metastasis from CRC in Fukuoka University Hospital between June 1991 and December 2004. These patients were grouped according to surgical therapy received for the metastases, and separated into two groups, as follows: LUM, lung metastases resection; LIM, liver metastases resection. We evaluated these groups for a set of several factors. RESULTS: The characteristic factors between the two groups (LUM vs. LIM) demonstrated significant differences according to histological differentiation, venous invasion, and lymphatic permeation. There was a statistical difference in the disease-free interval (DFI) between the two groups (947.06 +/- 840.39 days in LUM vs. 246.03 +/- 229.26 days in LIM). Although serum CEA levels at resection of metastasis showed significant differences between the groups (LUM, 13.25 +/- 31.55 ng/ml; LIM, 55.21 +/- 99.52 ng/ml), the primary serum CEA levels were not significantly different. Overall survival rates at 5 years were 37.0 % for LUM and 42.8 % for LIM. There was no significant difference in the survival rate of the LUM vs. the LIM group after resection of metastasis. The Cox proportional hazards regression model was used to determine serum CEA status at the time of the metastases and showed a significant difference indicating poor prognosis for patients with LUM, but the results were not significant for LIM cases. CONCLUSIONS: Candidates for surgical treatment for lung or liver metastases from CRC may be an acceptable for the same valuable approach, even if characteristic differences were observed in each group.