PDF(Pubmed)
Abstract：
BACKGROUND: Extracranial metastases occur in <2% of cases of glioblastoma (GBM). When metastases do occur, bone is the most common destination. Herein, we review clinical characteristics of GBM patients with osseous metastases and evaluate both potential risk factors and prognostic significance.
METHODS: Using an institutional database, we identified and retrospectively analyzed 6 patients with both GBM and osseous metastases. We collected data on patient demographics, tumor genetics, clinical courses, and outcomes. Given the rarity of metastatic GBM, we conducted historical comparisons using previously published literature.
RESULTS: Five patients with osseous metastases (83%) were male, with a median age of 46 years at GBM diagnosis (range: 20-84). All patients had IDH-wildtype, MGMT promoter unmethylated GBM and 5 (83%) had alterations in TP53. All patients underwent surgical resection for GBM followed by radiation with concurrent and adjuvant temozolomide. Four patients (67%) received bevacizumab prior to bone metastasis diagnosis. Bone metastases were discovered at a median of 12.2 months (range: 5.3-35.2) after GBM diagnosis and 4.8 months after starting bevacizumab (range: 3.5-13.2). Three patients (50%) received immunotherapy. After osseous metastasis diagnosis, the median survival was 25 days (range: 13-225).
CONCLUSIONS: In our cohort, most patients were male and young at the time of GBM diagnosis. All patients had IDH-wildtype, MGMT promoter unmethylated GBM, and most had alterations in TP53, which may be important for osseous metastasis. Most patients received bevacizumab, which has been associated with earlier metastasis. Osseous metastases of GBM occur and portend a dismal prognosis in an already aggressive malignancy.
METHODS: Using an institutional database, we identified and retrospectively analyzed 6 patients with both GBM and osseous metastases. We collected data on patient demographics, tumor genetics, clinical courses, and outcomes. Given the rarity of metastatic GBM, we conducted historical comparisons using previously published literature.
RESULTS: Five patients with osseous metastases (83%) were male, with a median age of 46 years at GBM diagnosis (range: 20-84). All patients had IDH-wildtype, MGMT promoter unmethylated GBM and 5 (83%) had alterations in TP53. All patients underwent surgical resection for GBM followed by radiation with concurrent and adjuvant temozolomide. Four patients (67%) received bevacizumab prior to bone metastasis diagnosis. Bone metastases were discovered at a median of 12.2 months (range: 5.3-35.2) after GBM diagnosis and 4.8 months after starting bevacizumab (range: 3.5-13.2). Three patients (50%) received immunotherapy. After osseous metastasis diagnosis, the median survival was 25 days (range: 13-225).
CONCLUSIONS: In our cohort, most patients were male and young at the time of GBM diagnosis. All patients had IDH-wildtype, MGMT promoter unmethylated GBM, and most had alterations in TP53, which may be important for osseous metastasis. Most patients received bevacizumab, which has been associated with earlier metastasis. Osseous metastases of GBM occur and portend a dismal prognosis in an already aggressive malignancy.
摘要：
背景：颅外转移发生在<2％的胶质母细胞瘤（GBM）病例中。当转移发生时，骨头是最常见的目的地。在这里，我们回顾了GBM骨转移患者的临床特征，并评估了潜在的危险因素和预后意义。
方法：使用机构数据库，我们确定并回顾性分析了6例GBM和骨转移患者。我们收集了病人的人口统计数据,肿瘤遗传学,临床课程，和结果。鉴于转移性GBM的稀有性，我们使用以前发表的文献进行了历史比较.
结果：5例骨转移患者（83%）为男性，GBM诊断时的中位年龄为46岁（范围：20-84）。所有患者均为IDH-野生型,MGMT启动子未甲基化的GBM和5(83%)在TP53中有改变。所有患者均接受GBM手术切除，然后进行同步和辅助替莫唑胺的放疗。4例患者（67%）在骨转移诊断前接受贝伐单抗治疗。在GBM诊断后12.2个月（范围：5.3-35.2）和开始贝伐单抗后4.8个月（范围：3.5-13.2）发现骨转移。3名患者（50%）接受了免疫治疗。骨转移诊断后，中位生存期为25天(范围:13-225).
结论：在我们的队列中，在GBM诊断时,大多数患者为男性和年轻.所有患者均为IDH-野生型,MGMT启动子未甲基化GBM,大多数TP53改变，这可能对骨转移很重要。大多数患者接受贝伐单抗治疗，这与早期转移有关。在已经侵袭性的恶性肿瘤中，GBM的骨性转移发生并预示着预后不良。
方法：使用机构数据库，我们确定并回顾性分析了6例GBM和骨转移患者。我们收集了病人的人口统计数据,肿瘤遗传学,临床课程，和结果。鉴于转移性GBM的稀有性，我们使用以前发表的文献进行了历史比较.
结果：5例骨转移患者（83%）为男性，GBM诊断时的中位年龄为46岁（范围：20-84）。所有患者均为IDH-野生型,MGMT启动子未甲基化的GBM和5(83%)在TP53中有改变。所有患者均接受GBM手术切除，然后进行同步和辅助替莫唑胺的放疗。4例患者（67%）在骨转移诊断前接受贝伐单抗治疗。在GBM诊断后12.2个月（范围：5.3-35.2）和开始贝伐单抗后4.8个月（范围：3.5-13.2）发现骨转移。3名患者（50%）接受了免疫治疗。骨转移诊断后，中位生存期为25天(范围:13-225).
结论：在我们的队列中，在GBM诊断时,大多数患者为男性和年轻.所有患者均为IDH-野生型,MGMT启动子未甲基化GBM,大多数TP53改变，这可能对骨转移很重要。大多数患者接受贝伐单抗治疗，这与早期转移有关。在已经侵袭性的恶性肿瘤中，GBM的骨性转移发生并预示着预后不良。
