Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2020; 12(2): 195-204
Published online Feb 15, 2020. doi: 10.4251/wjgo.v12.i2.195
Prognostic scoring system for synchronous brain metastasis at diagnosis of colorectal cancer: A population-based study
Ji-Chuan Quan, Xu Guan, Chen-Xi Ma, Zheng Liu, Ming Yang, Zhi-Xun Zhao, Peng Sun, Meng Zhuang, Song Wang, Zheng Jiang, Xi-Shan Wang
Ji-Chuan Quan, Xu Guan, Chen-Xi Ma, Zheng Liu, Ming Yang, Zhi-Xun Zhao, Meng Zhuang, Zheng Jiang, Xi-Shan Wang, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Peng Sun, Song Wang, Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
Author contributions: Quan JC and Guan X wrote the manuscript and contributed equally to this work; Jiang Z and Wang XS conceived and designed the study and are the co-corresponding authors; Quan JC, Guan X and Ma CX collected the data; Ma CX, Liu Z, Yang M, Zhao ZX, Zhuang M, Sun P and Wang S analyzed the data; all authors made critical revisions for the manuscript and approved the final version.
Supported by National Key Research and Development Program of the Ministry of Science and Technology of China, No. 2016YFC0905303, 2016YFC0905300; and Beijing Science and Technology Program, No. D171100002617004.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Informed consent statement: Informed consent was not required as the study is based on a publicly available database.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xi-Shan Wang, MD, Professor, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. wangxsh@126.com
Received: September 8, 2019
Peer-review started: September 8, 2019
First decision: November 11, 2019
Revised: November 14, 2019
Accepted: November 28, 2019
Article in press: November 28, 2019
Published online: February 15, 2020
Abstract
BACKGROUND

Brain metastasis (BM) from colorectal cancer (CRC) is rarely encountered clinically, and its prognosis has not been fully evaluated.

AIM

To construct a scoring system and accurately predict the survival of patients with synchronous BM at diagnosis of CRC.

METHODS

A retrospective study of 371 patients with synchronous BM from CRC was performed, using the data from 2010 to 2014 from the Surveillance, Epidemiology, and End Results database. Survival time and prognostic factors were statistically analyzed by the Kaplan-Meier method and Cox proportional hazards models, respectively. A scoring system was developed using the independent prognostic factors, and was used to measure the survival difference among different patients.

RESULTS

For the 371 patients, the median overall survival was 5 mo, survival rates were 27% at 1 year and 11.2% at 2 years. Prognostic analysis showed that age, carcinoembryonic antigen level and extracranial metastasis to the liver, lung or bone were independent prognostic factors. A scoring system based on these three prognostic factors classified the patients into three prognostic subgroups (scores of 0-1, 2-3, and 4). The median survival of patients with scores of 0-1, 2-3 and 4 was 14, 5 and 2 mo, respectively (P < 0.001). Subgroup analysis showed that there were significant differences in prognosis among the groups. Score 2-3 vs 0-1: hazard ratio (HR) = 2.050, 95%CI: 1.363-3.083; P = 0.001; score 4 vs 0-1: HR = 3.721, 95%CI: 2.225-6.225; P < 0.001; score 2-3 vs 4: HR = 0.551, 95%CI: 0.374-0.812; P = 0.003.

CONCLUSION

The scoring system effectively distinguishes long-term and short-term survivors with synchronous BM from CRC. These results are helpful in providing a reference for guiding therapy.

Keywords: Colorectal cancer, Brain metastasis, Survival, Prognosis factors, Scoring system, Synchronous

Core tip: There is no prognostic scoring system specifically for synchronous brain metastasis (BM) from colorectal cancer (CRC). This is believed to be the first study to construct such a system. We found that the scoring system accurately distinguished survival differences among patients, which contributed to the individual management of patients with BM from CRC.