P14.13 Clinical and pathologic features for survival in gastric cancer with brain metastasis

Abstract

INTRODUCTION: Brain metastases from gastric cancer is exceedingly rare. This study sought to analyze the clinical features of gastric cancer and brain metastasis and prognostic factors for patient survival. MATERIALS AND METHODS: Fourteen cases of histologically confirmed advanced gastric cancer with brain metastases treated at our center between January 1996 and June 2015 were analyzed retrospectively. RESULTS: The median patient age was 64 years (range 51-75 years), and half of the patients had poorly differentiated adenocarcinoma. Human epidermal growth factor receptor 2 (HER-2) positivity by immunohistochemistry was observed in 5 patients. (35%) Ten patients had multiple brain lesions, and concurrent systemic metastases was found in 11 patients, commonly involving the liver. Twelve patients received steroids plus whole-brain radiation, and surgical resection of a single brain lesion was performed in 1 patient, who experienced a complete response. None of the patients received stereotactic radiosurgery (SRS). The median survival after the detection of brain metastases was 12 weeks (range, 2-48.4 weeks). Univariate analysis revealed that poor survival was associated with increased levels of serum lactate dehydrogenase (p= 0.005), unfavorable performance status (p= 0.021), and worsening neurological function after treatment for brain metastasis (p= 0.007). In multivariate analysis, worsening neurological function after treatment for brain lesions (hazard ratio 5.5, 95% confidence interval 1.49-20.5, p= 0.011) was confirmed as a significant prognostic factor for poor survival. CONCLUSIONS: Deterioration in neurological function after treatment for brain metastases was an unfavorable prognostic factor for patient survival. HER-2 overexpression seems to be associated with higher risk for brain metastases in gastric cancer. Despite the dismal prognosis of gastric cancer, multidisciplinary treatment including WBRT, surgical resection, and SRS is needed to improve the quality of life and prolong survival for gastric cancer patients with brain metastases.