Dados do Trabalho

Título

RETROSPECTIVE EVALUATION OF PATIENTS WITH COLORECTAL CANCER WITH METASTASIS IN THE CENTRAL NERVOUS SYSTEM: CLINICAL AND EPIDEMIOLOGICAL PROGNOSTIC FACTORS

Introdução

Metastasis of colorectal cancer (CRC) to the central nervous system (CNS) is relatively rare but leads to shorter survival of these patients (pts) even with improvement of palliative treatments. The aim of this study was to evaluate the epidemiological profile and the prognostic factors of pts with CRC and metastasis to CNS.

Objetivo

Conduct an epidemiological survey and evaluate the clinical and pathological prognostic factors of patients with CRC with metastasis in the CNS, treated at the AC Camargo Cancer Center.

Método

We evaluated patients with metastatic CRC and CNS involvement treated from Jan 2002 to Aug 2020 in a single cancer center institution. We used summary statistics to describe the population. Overall survival (OS) was calculated according to the Kaplan-Meier method. We performed univariate analysis to evaluate potential prognostics factors for OS using SPSS software version 24.

Resultado

We identified 46 pts with a median age of 63,9 years (39,3 - 86,3) and 80% have good performance status (ECOG 0-1). The predominant primary side was the left side (71,7%). 60,5% were stage IV, 71,7% previously presented lung metastasis and 76,7% had a high volume of lung disease (2 or more nodes). No MSI-High or BRAF mutations were detected. RAS mutation was detected in 56,5% of the pts. In the first line, the most used chemotherapy regimen was oxaliplatin doublet (51,1%), with disease control in 83,7% of cases. 68,3% presented lung progression to the first line. Overall, 65,2% used anti-VEGF. Progression to CNS occurred after a median of 3 treatment lines, the median time between diagnosis and progression to CNS was 49,5 months, 33 months after the first-line treatment and 19,3 months after lung metastasis. The median CEA at CNS metastasis was 45. Headache (26,7%) and motor alterations (24,4%) were the most common symptoms but 15,6% of the pts were asymptomatic. 60,9% had supratentorial nodes and 55,6% had just one lesion, with 24mm median size. After a median follow up time of 27,2 months, the OS was 6,4 months (1.6 to 11,1). The use of anti-EGFR therapy and the RAS mutation had no impact on survival (p> 0.2). 32,6% underwent brain metastasis resection (HR 0,25; p<0,01; 95% CI 0,09 - 0,68) and 65,2% received CNS radiation (HR 0,2; p<0,01; 95% CI 0,08 - 0,51).

Conclusão

This study found that pts with CCR with this profile should be systematically screened for CNS metastasis once treating CNS metastasis decreases mortality. Our findings must be validated with a larger cohort of patients.

Palavras-chave

colorectal cancer, metastasis, central nervous system