title: The incidence and outcome of brain metastases after liver resection for colorectal cancer metastases.
abstract: OBJECTIVE
  Brain metastases from colorectal cancer are rare, with an incidence of 0.6-4%. The risk and outcome of brain metastases after hepatic and pulmonary metastasectomy have not been previously described. This study aimed to determine the incidence, predictive factors, treatment and survival of patients developing colorectal brain metastases, who had previously undergone resection of hepatic metastases.
  
  
  METHODS
  A retrospective review was carried out of a prospectively maintained database of patients undergoing liver resection for colorectal metastases.
  
  
  RESULTS
  Fifty-two (4.0%) of 1304 patients were diagnosed with brain metastases. The annual incidence rate was 1.03% per person-year. In the majority of cases brain metastases were found as part of multifocal disease. Median survival was 3.2 months (95% CI: 2.3-4.1), but was best for six patients treated with potentially curative resection [median survival = 13.2 (range, 4.9-32.1) months]. Multivariate analysis showed that a lymph node-positive primary tumour [hazard ratio (HR) = 2.7, 95% CI: 1.8-6.19; P = 0.019], large liver metastases (> 6 cm) [HR = 2.23, 95% CI: 1.19-2.33; P = 0.012] and recurrent intrahepatic and extrahepatic disease [HR = 2.11, 95% CI: 1.2-4.62; P = 0.013] were independent predictors for the development of brain metastases.
  
  
  CONCLUSIONS
  The annual risk of developing brain metastases following liver resection for colorectal metastases is low, but highest for patients presenting with a Dukes' C primary tumour, large liver metastases or who subsequently develop disseminated disease. The overall survival from colorectal brain metastases is poor, but resection with curative intent offers patients their best chance of medium-term survival.
authors.affiliation: Hepatobiliary Unit, Basingstoke & North Hampshire NHS Foundation Trust, Basingstoke, UK.
authors.forename: B E
authors.initials: BE
authors.lastname: Byrne
authors.forename: T
authors.initials: T
authors.lastname: Geddes
authors.forename: F K S
authors.initials: FK
authors.lastname: Welsh
authors.forename: T G
authors.initials: TG
authors.lastname: John
authors.forename: K
authors.initials: K
authors.lastname: Chandrakumaran
authors.forename: M
authors.initials: M
authors.lastname: Rees
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000556:secondary; D001932:Brain Neoplasms / Q000453:epidemiology* / Q000556:secondary* / Q000628:therapy; D002277:Carcinoma / Q000556:secondary / Q000628:therapy; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008175:Lung Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors