Journal of thoracic disease · 2025
Incidence and prognosis of brain metastases in esophageal carcinoma: a systematic review and meta-analysis.
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Hong Haojun, Ding Jiapeng, Yuan Chang, Qi Cong, Jing Chenyang, Fan Xinyi, Yu Boyao, Yang Yuxin, Li Chunguang, Liu Zhichao, Li Zhigang
Аннотация
BACKGROUND: Brain metastases (BMs) are associated with rapid progression and substantial morbidity. In recent years, the incidence of brain metastases from esophageal carcinoma (BMECs) has increased, despite remaining relatively rare. However, there is still a limited understanding of the diagnostic and therapeutic strategies for BMECs. A comprehensive understanding of BMEC is critical to inform timely neuroimaging surveillance and guide treatment. This systematic review and meta-analysis aimed to characterize the incidence, presentation and prognosis of BMECs.
METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic search was conducted across PubMed/MEDLINE, EMBASE, and Cochrane Library until January 2025. Studies reporting incidence rates or survival data for histologically confirmed esophageal carcinoma with radiologically verified BMs were eligible. Two independent reviewers extracted data using standardized forms encompassing: (I) demographic variables; (II) primary tumor characteristics; and (III) metastatic parameters.
RESULTS: A total of 31 eligible studies met the inclusion criteria. The pooled incidence of BMECs was 2.84% [95% confidence interval (CI): 1.92-4.19%]. Notably, patients with adenocarcinoma exhibited a significantly higher incidence of BMECs compared to those with squamous cell carcinomas (SCCs) [5.34% (95% CI: 3.52-8.12%) vs. 1.45% (95% CI: 0.84-2.53%), P<0.001]. The pooled median overall survival (OS) following a BMEC diagnosis was 5.62 months (95% CI: 3.98-7.94). Furthermore, resection of BMs was significantly associated with improved OS [hazard ratio (HR): 0.45 (95% CI: 0.33-0.61), P<0.001], while multiple BMs [HR: 1.66 (95% CI: 1.27-2.16), P<0.001] and BMECs presenting with extracranial metastasis [HR: 1.52 (95% CI: 1.11-2.09), P=0.01] were significantly associated with worse OS.
CONCLUSIONS: Comprehensive meta-analysis indicates BMEC as an uncommon but severe event in patients with esophageal carcinoma, demonstrating a poor prognosis of BMEC and a higher prevalence and incidence of BMs in adenocarcinoma. These findings support the regular use of brain imaging at staging and neuroimaging surveillance at follow-up in patients with esophageal carcinoma. Future research directions should focus on developing precise BM risk prediction tools and prospective studies to establish optimal treatment for BMECs.
METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic search was conducted across PubMed/MEDLINE, EMBASE, and Cochrane Library until January 2025. Studies reporting incidence rates or survival data for histologically confirmed esophageal carcinoma with radiologically verified BMs were eligible. Two independent reviewers extracted data using standardized forms encompassing: (I) demographic variables; (II) primary tumor characteristics; and (III) metastatic parameters.
RESULTS: A total of 31 eligible studies met the inclusion criteria. The pooled incidence of BMECs was 2.84% [95% confidence interval (CI): 1.92-4.19%]. Notably, patients with adenocarcinoma exhibited a significantly higher incidence of BMECs compared to those with squamous cell carcinomas (SCCs) [5.34% (95% CI: 3.52-8.12%) vs. 1.45% (95% CI: 0.84-2.53%), P<0.001]. The pooled median overall survival (OS) following a BMEC diagnosis was 5.62 months (95% CI: 3.98-7.94). Furthermore, resection of BMs was significantly associated with improved OS [hazard ratio (HR): 0.45 (95% CI: 0.33-0.61), P<0.001], while multiple BMs [HR: 1.66 (95% CI: 1.27-2.16), P<0.001] and BMECs presenting with extracranial metastasis [HR: 1.52 (95% CI: 1.11-2.09), P=0.01] were significantly associated with worse OS.
CONCLUSIONS: Comprehensive meta-analysis indicates BMEC as an uncommon but severe event in patients with esophageal carcinoma, demonstrating a poor prognosis of BMEC and a higher prevalence and incidence of BMs in adenocarcinoma. These findings support the regular use of brain imaging at staging and neuroimaging surveillance at follow-up in patients with esophageal carcinoma. Future research directions should focus on developing precise BM risk prediction tools and prospective studies to establish optimal treatment for BMECs.