Survival and Prognostic Factors in Patients with Gastrointestinal Cancers and Brain Metastases

Abstract

Literature is sparse regarding the prognosis of patients with gastrointestinal (GI) cancers and brain metastases (BM). Our group previously published a prognostic index, the Graded Prognostic Assessment (GPA) for GI cancer patients with BM, based on 209 patients diagnosed from 1985-2005. The purpose of this analysis is to identify prognostic factors for GI cancer patients with newly diagnosed BM in a larger contemporary cohort. A multi-institutional (16) retrospective institutional review board-approved database of 685 GI cancer patients with new BM diagnosed from 1/1/2006-12/31/2016 was created using REDCap. Demographic data, clinical parameters and treatment were correlated with survival, time from primary diagnosis to BM (TPDBM) and cause of death. Kaplan-Meier median survival estimates were calculated and compared with log-rank tests. The median survival (MS) from time of first treatment for BM for the prior and current cohorts were 5 and 7 months, respectively (p<0.001). Eight prognostic factors (GI GPA, age, stage, KPS, extracranial metastases (ECM), number of BM, primary site and Hgb at the time of BM diagnosis) were found to be statistically significant for survival, in contrast to only one (KPS) in the prior cohort. MS (mo) by primary site were: stomach (2), transverse colon (2), pancreas (4), GE junction (4), Gallbladder (5), Left and right colon (7), rectum (7), esophagus (9), small bowel (9), rectosigmoid (10) and anus (14). Median TPDBM was 22 months. Shorter TPDBM was seen with esophageal, gastroesophageal junction, gastric cancers. The cause of death was known in 54% (370/685) and among those, neurologic only death occurred in 25% (92/370). Nearly one third of patients (219/685) presented with poor prognosis (GPA 0-1.0).Abstract MO_29_2736; Table 1FactorRangeNOS (mo)p-valueOverall1985-2005 / 2006-2016209 / 6855 / 7<0.001GPA0-1 / 1.5-2 / 2.5-3 / 3.5-4.0219 / 179 / 177 / 394 / 6 / 11 / 14<0.001KPS<70 / 70 / 80 / 90 / 10095 / 124 / 179 / 177 / 393 / 4 / 6 / 11 / 14<0.001# Brain Mets1 / 2-3 / >3337 / 204 / 13710 / 7 / 3<0.001Hgb< 11 / 11-12.5 / 12.6-14 / > 14113 /110 / 118 / 1163 /6 / 7 / 11<0.001Age25-52 / 53-61 / 62-68 / > 68166 / 163 / 190 / 16610 / 8 / 7 / 50.002StageI / II / III / IV / unknown27 / 79 / 221 / 294 / 647 / 11 / 9 / 6 / 70.004HER2negative / positive / unknown82 / 48 / 5555 / 11 / 70.06 Open table in a new tab OS has improved slightly in recent decades and varies by primary site. In stark contrast to our studies of patients with lung, melanoma, breast and renal cell cancers, a much higher percentage (32%) of GI patients with BM present with poor prognosis (GPA 0-1.0), highlighting the need for earlier diagnosis and better treatment. More prognostic factors have been identified. The impact of HER2/KRAS/EGFR/BRAF on OS by primary site will be presented. These data will be useful in counseling patients, refining clinical decision-making and the GI-GPA index and stratification of future clinical trials.