Abstract
BackgroundBrain metastases were rare in esophageal cancer patients. Using the Surveillance, Epidemiology, and End Results (SEER) database, the present study investigated the incidence, risk and prognostic factors of brain metastases in esophageal cancer patients.MethodsRetrieving esophageal cancer patients diagnosed between 2010 and 2018 from the SEER database, univariable and multivariable logistic and cox regression models were used to investigate the risk factors for brain metastases development and prognosis, respectively. The brain metastases predicting nomogram was constructed, evaluated and validated. The overall survival (OS) of patients with brain metastases was analyzed by Kaplan–Meier method.ResultsA total of 34,107 eligible esophageal cancer patients were included and 618 of them were diagnosed with brain metastases (1.8%). The median survival of the brain metastatic esophageal cancer patients was 5 (95% CI: 5–7) months. The presence of bone metastases and lung metastases were the homogeneously associated factors for the development and prognosis of brain metastases in esophageal cancer patients. Patients younger than 65 years, American Indian/Alaska Native race (vs. White), overlapping lesion (vs. Upper third), esophageal adenocarcinoma histology subtype, higher N stage, and liver metastases were positively associated with brain metastases occurrence. The calibration curve, ROC curve, and C-index exhibited good performance of the nomogram for predicting brain metastases.ConclusionsHomogeneous and heterogeneous factors were found for the development and prognosis of brain metastases in esophageal cancer patients. The nomogram had good calibration and discrimination for predicting brain metastases.
Highlights
Brain metastases were rare in esophageal cancer patients
618 (1.8%) esophageal cancer patients were initially diagnosed with brain metastases
More cancers were diagnosed at grade III (42.6%) and N1 (47.6%). 30.3% patients were diagnosed with bone metastases, 37.9% patients with liver metastases and 30.9% patients with lung metastases
Summary
Brain metastases were rare in esophageal cancer patients. Using the Surveillance, Epidemiology, and End Results (SEER) database, the present study investigated the incidence, risk and prognostic factors of brain metastases in esophageal cancer patients. An estimated 604,000 new esophageal cancer cases. European Society for Medical Oncology (ESMO) guidelines for staging do not recommend performing routine brain imaging in asymptomatic esophageal patients [7]. A predictive nomogram based on the clinicopathologic features of esophageal cancer patients is urgently needed to facilitate metastatic screening. The purpose of the present study was to summarize the incidence, the risk factors, and the prognostic factors of brain metastases in esophageal cancer patients using the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2018. A predictive nomogram was developed and validated to guide the brain metastases screening
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