Brain metastases from hepatopancreatobiliary malignancies.

Area of Science:

• Oncology
• Neuro-oncology
• Gastroenterology

Background:

• Brain metastases (BM) are common in gastrointestinal cancers, but data on hepatopancreatobiliary (HPB) malignancies are scarce.
• HPB tumors include cholangiocarcinoma (CCA), hepatocellular carcinoma (HCC), pancreatic ductal adenocarcinoma (PDAC), and gastroenteropancreatic neuroendocrine neoplasms (GEP NEN).

Purpose of the Study:

• To investigate the clinical course and prognostic factors of brain metastases in patients with primary hepatopancreatobiliary malignancies.
• To analyze brain metastases-free survival (BMFS) and overall survival (OS) in this patient cohort.

Main Methods:

• Retrospective analysis of 29 patients with BM from HPB primaries treated between 1991 and 2017.
• Data collected from the Vienna Brain Metastasis Registry, including primary tumor type, BMFS, OS, and clinical factors.
• Cox proportional hazards model used to correlate outcomes with clinical and treatment factors.

Main Results:

• BM from HPB primaries occurred in 0.6% of patients (29/6102).
• Median BMFS varied by primary tumor: CCA (21 months), HCC (12 months), PDAC (14 months), GEP NEN (7 months).
• Median OS was limited across all HPB BM types (4-6 months). Karnofsky Performance Status <80%, age >60, and leptomeningeal carcinomatosis were associated with poorer OS.

Conclusions:

• Prognosis for patients with BM from HPB tumors is very limited.
• Performance status, age, and leptomeningeal carcinomatosis are significant negative prognostic factors.
• Further research is needed to improve outcomes for this rare patient population.