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Colorectal Cancer Metastases to Brain or Bone and the Relationship to Primary Tumor Location: a Population-Based Study

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The association of primary tumor location with incidence and prognosis of brain or bone metastasis in metastatic colorectal cancer (mCRC) patients remains unclear. We dissect this association across a large population.

Methods

A total of 202,401 CRC patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 were included. For brain metastasis, 9478 cases without brain metastasis information were excluded, leaving 192,923 CRC for incidence analysis and multivariable logistic/Cox regression analyses. Similarly, 193,013 CRC were eligible for bone metastasis analyses.

Results

The incidence of brain or bone metastasis at initial diagnosis was 1.38% and 6.12% in mCRC cohort, respectively. Median survival of CRC patients with brain or bone metastasis was 4 and 5 months, respectively. Primary tumor location is not associated with the incidence of brain metastasis but with bone metastasis. For bone metastasis, right-sided colon cancer (RCC) patients exhibited the lowest incidence, whereas rectal cancer (RC) patients had the highest. For both brain and bone metastases, RCC patients always had the shortest median survival, whereas RC patients had the longest. The common risk factors for brain or bone metastasis were grade III and multi-extracerebral or ectosteal metastases. The favorable prognostic factors for brain or bone metastasis were being female, married, insured, and RC. RCC is an unfavorable prognostic factor.

Conclusions

Primary tumor location impacts incidence proportions of bone metastasis and survival of both brain and bone mCRC patients. Primary tumor location should be taken into consideration in clinical practice and prognostic assessment.

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Acknowledgments

We thank the Surveillance, Epidemiology, and End Results (SEER) Program for kindly providing the clinical data.

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Author notes

  1. Shijun Lei and Yizhi Ge contributed equally to this work.

Authors and Affiliations

  1. Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Shijun Lei, Yizhi Ge, Shaobo Tian, Bo Cai, Ning Wang, Lin Wang & Zheng Wang

  2. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Shaobo Tian, Guobin Wang & Zheng Wang

  3. Jame J. Peters VA Medical Center, Bronx, NY, 10468, USA

    Xiang Gao

  4. Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Lin Wang

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  1. Shijun Lei
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Contributions

Shijun Lei and Yizhi Ge: Research design, data collection, interpretation and analysis, manuscript drafting. They contribute equally to this work. Shaobo Tian, Bo Cai, Xiang Gao, and Ning Wang: Work design and manuscript’s critical revision for main intellectual content. Guobin Wang, Lin Wang, and Zheng Wang: Research design, data analysis, results interpretation, paper writing, and critical revision of the manuscript. All authors approved the final version and agreed to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Guobin Wang, Lin Wang or Zheng Wang.

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Conflict of Interest

The authors declare that they have no competing interests.

Financial Support

This work was supported by the Major State Basic Research Development Program of China (973 Program, 2015CB554007), the Integrated Innovative Team for Major Human Diseases Program of Tongji Medical College, HUST, and the Academic Medical Doctor Supporting Program of Tongji Medical College, HUST.

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Lei, S., Ge, Y., Tian, S. et al. Colorectal Cancer Metastases to Brain or Bone and the Relationship to Primary Tumor Location: a Population-Based Study. J Gastrointest Surg 24, 1833–1842 (2020). https://doi.org/10.1007/s11605-019-04308-8

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  • DOI: https://doi.org/10.1007/s11605-019-04308-8

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