Analysis of clinicopathological characteristics and prognostic factors of 63 esophageal carcinoma patients with brain metastasis

Abstract

Objective Brain metastasis is rare in patients with esophageal carcinoma (EC). The purpose of this study is to investigate clinicopathological characteristics and prognostic factors of EC patients with brain metastasis so as to provide some references for diagnosis and treatments of these patients. Methods We retrospectively reviewed 63 cases of EC with brain metastasis from January 1, 2009 to December 31, 2018 in the Fourth Hospital of Hebei Medical University. There were 52 patients with esophageal squamous cell carcinoma, 3 patients with esophageal adenocarcinoma and 8 patients with esophageal small cell carcinoma. 41 patients received craniocerebral radiotherapy (22 patients only received craniocerebral radiotherapy, 19 patients received craniocerebral radiotherapy and/or chemotherapy/targeted drug), 6 patients only received chemotherapy, and 16 patients only received symptomatic treatment. These patients were graded according to the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA). 12 patients scored 0, 20 patients scored 1, 22 patients scored 2 and 9 patients scored 3. Results All the patients were followed up until March 20, 2019.56 patients died, 4 patients survived and 3 patients missed the follow-up. The follow-up rate was 95.23%. The mean interval time from the diagnosis of EC to the diagnosis of brain metastasis was (22.6±40.9) months, and the median time was 9 months (0~249.2 months). Brain metastasis occurred within six months after diagnosis of EC in 12 patients. The median overall survival (OS) in the whole group was 8.9 months (0.4~45.8 months). The median OS was 10.9 months (1.7~45.8 months) and 3.4 months (0.4~32.7 months) in the groups of patients with and without craniocerebral radiotherapy, respectively, while there were no statistical differences between the two groups (χ2=1.205, P=0.272). Univariate analysis showed that DS-GPA score and extracranial metastasis were the independent factors of OS. The median OS of patients with DS-GPA 0, 1, 2 and 3 were 2.9 months, 9.7 months, 8.4 months and 12.7 months, respectively (χ2=9.291, P=0.026). The median OS of patients with and without extracranial metastasis were 7.2 months and 12.0 months, respectively (χ2=4.876, P=0.027). Conclusions DS-GPA score and extracranial metastasis are the independent factors influencing prognosis of EC patients with brain metastasis. Patients with a better Karnofsky (KPS) score and without extracranial metastasis have better survival. Craniocerebral radiotherapy is still a good treatment option for patients with an expected survival of more than 3 months. Key words: Esophageal carcinoma; Brain metastasis; Radiotherapy; DS-GPA; Prognosis