Background:The development of brain metastases (BM) is a relatively uncommon but significantly adverse event in the spread of colorectal cancer (CRC). Although management of CRC BM has improved with advances in imaging and systemic therapies, clinical outcomes remain poor.Methods:This retrospective cohort study used the U.S. National Cancer Database to evaluate survival outcomes, treatment patterns, and prognostic factors in CRC patients diagnosed with BM between 2010 and 2020. Patients with isolated brain-only metastases formed the primary analytic cohort, while those with additional extracranial metastases were included for descriptive comparison. Multivariable Cox proportional hazards and logistic regression models were used to assess factors associated with of survival. Proportional hazards assumptions were tested using Schoenfeld residuals. Accelerated failure time models were also employed.Results:From a cohort of 1,040,877 individuals with CRC, 795 had metastatic disease present along with relevant data, of which 296 had isolated BM. Median overall survival (mOS) in BM-only metastatic disease group was 7.82 months (95% CI: 5.82–9.66). The longest survival was observed among patients treated with stereotactic radiosurgery combined with systemic therapy (SRS+Sys), with a median OS of 23.26 months (95% CI: 17.51–41.95) and a 3-year survival rate of 35.8%. In adjusted Cox models, SRS, systemic therapy, and definitive surgery of the primary site were each independently associated with reduced hazard of death. Rectal cancer patients had longer survival than those with colon primaries (mOS: 10.35 vs. 6.08 months). Age, comorbidity burden, and insurance status were not associated with survival in adjusted analyses.Conclusions:SRS+Sys was associated with longer survival compared to other treatment strategies. However, treatment selection is highly dependent on individual clinical factors such as performance status, comorbidities, and disease extent; therefore, these findings must be interpreted with caution Future prospective studies incorporating molecular and biomarker data are warranted to better guide care in this rare and high-risk group.
背景：脑转移是结直肠癌播散过程中相对少见但预后极差的事件。尽管影像学和全身治疗的进步改善了结直肠癌脑转移的治疗，但临床结局仍然不佳。 方法：本回顾性队列研究利用美国国家癌症数据库，评估2010年至2020年间诊断为脑转移的结直肠癌患者的生存结局、治疗模式和预后因素。研究以单纯脑转移患者为主要分析队列，同时纳入合并颅外转移者进行描述性比较。采用多变量Cox比例风险模型和逻辑回归模型分析生存相关因素，并通过Schoenfeld残差检验比例风险假设，同时使用加速失效时间模型进行验证。 结果：在1,040,877例结直肠癌患者队列中，795例存在转移性疾病且数据完整，其中296例为单纯脑转移。单纯脑转移组的中位总生存期为7.82个月（95% CI：5.82-9.66）。接受立体定向放射外科联合全身治疗的患者生存期最长，中位总生存期达23.26个月（95% CI：17.51-41.95），3年生存率为35.8%。校正后的Cox模型显示，立体定向放射外科、全身治疗和原发灶根治性手术均与死亡风险降低独立相关。直肠癌患者生存期长于结肠癌患者（中位总生存期：10.35个月 vs 6.08个月）。在调整分析中，年龄、合并症负担和保险状态与生存无显著相关性。 结论：与其他治疗策略相比，立体定向放射外科联合全身治疗与更长的生存期相关。然而，治疗方案的选择高度依赖于患者个体临床因素，如体能状态、合并症和疾病范围，因此需谨慎解读本研究结果。未来有必要开展纳入分子标志物数据的前瞻性研究，以更好地指导这一罕见高危人群的临床治疗。
肿瘤(癌症)患者之家