目的:本研究旨在确定与高级别胶质瘤(HGG)患者软脑膜扩散(LMS)后生存相关的预后因素,并阐明其行为和治疗反应。
方法:这项回顾性研究包括2014年8月1日至2021年7月30日在我们机构诊断为LMS的114例HGG患者。临床,放射学,病态,并收集结果数据。单变量和多变量Cox回归用于总生存期(OS)和LMS后生存期(PLS)分析。
结果:中位OS为17.0个月,中位PLS为6.0个月。LMS诊断后的大体全切除(GTR)和病理III级与所有患者的OS延长有统计学意义。LMS诊断后的GTR和结节性LMS是PLS的独立有利预后因素。LMS诊断后的非辅助治疗与较短的OS和PLS相关。在胶质母细胞瘤(GBM)亚组分析中,LMS诊断后的GTR和继发性LMS是OS的独立有利预后因素。在LMS诊断时,Karnofsky表现状态(KPS)≥80,LMS和鞘内注射甲氨蝶呤(MTX)治疗后的化疗与较长的PLS有统计学显著相关.II型MRI是较短PLS的预测因子。
结论:诊断为LMS后的胶质瘤患者的治疗非常具有挑战性和局限性。LMS后肿瘤的安全GTR和后续辅助治疗仍然是提高LMS患者生存率的有力武器。化疗和鞘内注射MTX治疗是LMS后可行的治疗方法。肿瘤播散的程度可能影响LMS后的生存率。
OBJECTIVE: This study aimed to identify prognostic factors associated with survival in patients with high-grade glioma (HGG) after leptomeningeal spread (LMS) and to clarify the behavior and treatment response.
METHODS: This retrospective study included 114 patients with HGGs diagnosed with LMS from August 1, 2014, to July 30, 2021, at our institution. Clinical, radiological, pathological, and outcome data were collected. Univariable and multivariable Cox regression were used for overall survival (OS) and post-LMS survival (PLS) analysis.
RESULTS: The median OS was 17.0 months and the median PLS was 6.0 months. Gross total resection (GTR) after LMS diagnosis and pathology grade III were statistically significantly associated with longer OS in all patients. GTR after LMS diagnosis and nodular LMS were independent favorable prognostic factors on PLS. Non-adjuvant therapy after LMS diagnosis was associated with shorter OS and PLS. In glioblastoma (GBM) subgroup analysis, GTR after LMS diagnosis and secondary LMS were independent favorable prognostic factors on OS. Karnofsky Performance Status (KPS) of ≥80 at LMS diagnosis, chemotherapy after LMS and intrathecal methotrexate (MTX) treatment were statistically significantly associated with longer PLS. MRI type II was a predictor of shorter PLS.
CONCLUSIONS: The treatment of patients with glioma after LMS diagnosis is very challenging and limited. Safe GTR of tumor and subsequent adjuvant therapy after LMS remains a powerful weapon to improve survival for HGG patients with LMS. Chemotherapy and Intrathecal MTX treatment are feasible treatments after LMS. The extent of tumor dissemination may affect the survival after LMS.