胃脑膜转移瘤：54 例多中心回顾性分析。
Gastric leptomeningeal carcinomatosis: multi-center retrospective analysis of 54 cases.
机构信息
Department of Internal Medicine, Dong-A University College of Medicine, 3-1 Dongdaeshin-dong, Seo-gu, Busan 602-715, South Korea.
出版信息
World J Gastroenterol. 2009 Oct 28;15(40):5086-90. doi: 10.3748/wjg.15.5086.
AIM
To identify the clinical features and outcomes of infrequently reported leptomeningeal carcinomatosis (LMC) of gastric cancer.
METHODS
We analyzed 54 cases of cytologically confirmed gastric LMC at four institutions from 1994 to 2007.
RESULTS
The male-to-female ratio was 32:22, and the patients ranged in age from 28 to 78 years (median, 48.5 years). The majority of patients had advanced disease at initial diagnosis of gastric cancer. The clinical or pathologic tumor, node and metastasis stage of the primary gastric cancer was IV in 38 patients (70%). The median interval from diagnosis of the primary malignancy to the diagnosis of LMC was 6.3 mo, ranging between 0 and 73.1 mo. Of the initial endoscopic findings for the 45 available patients, 23 (51%) of the patients were Bormann type III and 15 (33%) patients were Bormann type IV. Pathologically, 94% of cases proved to be poorly differentiated adenocarcinomas. Signet ring cell component was also observed in 40% of patients. Headache (85%) and nausea/vomiting (58%) were the most common presenting symptoms of LMC. A gadolinium-enhanced magnetic resonance imaging was conducted in 51 patients. Leptomeningeal enhancement was noted in 45 cases (82%). Intrathecal (IT) chemotherapy was administered to 36 patients-primarily methotrexate alone (61%), but also in combination with hydrocortisone/+/- Ara-C (39%). The median number of IT treatments was 7 (range, 1-18). Concomitant radiotherapy was administered to 18 patients, and concomitant chemotherapy to seven patients. Seventeen patients (46%) achieved cytological negative conversion. Median overall survival duration from the diagnosis of LMC was 6.7 wk (95% CI: 4.3-9.1 wk). In the univariate analysis of survival duration, hemoglobin, IT chemotherapy, and cytological negative conversion showed superior survival duration (P = 0.038, P = 0.010, and P = 0.002, respectively). However, in our multivariate analysis, only cytological negative conversion was predictive of relatively longer survival duration (3.6, 6.7 and 14.6 wk, P = 0.030, RR: 0.415, 95% CI: 0.188-0.918).
CONCLUSION
Although these patients had a fatal clinical course, cytologic negative conversion by IT chemotherapy may improve survival.
目的
明确胃癌少见脑膜转移（LMC）的临床特征和预后。
方法
我们分析了 1994 年至 2007 年 4 家机构的 54 例经细胞学证实的胃 LMC 患者。
结果
男/女比例为 32:22，年龄 2878 岁，中位年龄 48.5 岁。大多数患者在确诊胃癌时已处于晚期。38 例（70%）患者的胃癌原发灶临床或病理肿瘤、淋巴结和转移分期为 IV 期。从原发恶性肿瘤诊断到 LMC 诊断的中位时间为 6.3 个月，范围为 073.1 个月。45 例可评估初始内镜检查结果中，23 例（51%）为 Bormann Ⅲ型，15 例（33%）为 Bormann Ⅳ型。病理上，94%的病例证实为低分化腺癌。40%的患者也观察到印戒细胞成分。脑膜转移的最常见表现为头痛（85%）和恶心/呕吐（58%）。51 例患者行钆增强磁共振成像检查，45 例（82%）发现脑膜强化。36 例患者接受鞘内（IT）化疗，主要为甲氨蝶呤单药（61%），但也有联合地塞米松/阿糖胞苷（39%）。IT 治疗的中位数为 7 次（范围为 118 次）。18 例患者同时接受放疗，7 例患者同时接受化疗。17 例（46%）患者实现细胞学阴性转化。从 LMC 诊断开始的中位总生存时间为 6.7 周（95%CI：4.39.1 周）。在生存时间的单因素分析中，血红蛋白、IT 化疗和细胞学阴性转换显示出较好的生存时间（P=0.038，P=0.010，P=0.002）。然而，在我们的多因素分析中，只有细胞学阴性转换与较长的生存时间相关（3.6、6.7 和 14.6 周，P=0.030，RR：0.415，95%CI：0.188~0.918）。
结论
尽管这些患者的临床病程是致命的，但 IT 化疗的细胞学阴性转化可能改善生存。
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