Cacho-Díaz Bernardo, Lorenzana-Mendoza Nydia A, Reyes-Soto Gervith, Hernández-Estrada Allan, Monroy-Sosa Alejandro, Guraieb-Chahin Paola, Cantu-de-León David
Neuro-oncology Unit, Instituto Nacional de Cancerología, Mexico City, Mexico.
Neuro-oncology Unit, Instituto Nacional de Cancerología, Mexico City, Mexico.
J Clin Neurosci. 2018 May;51:39-42. doi: 10.1016/j.jocn.2018.02.014. Epub 2018 Feb 23.
This study aimed to establish the prognostic utility of lactate dehydrogenase (LDH) levels in the cerebrospinal fluid (CSF) of patients with neoplastic meningitis (NM). Patients with a confirmed diagnosis of NM at a cancer referral center were included. Data on demographic and oncological background, clinical symptoms, diagnostic tests, treatment, and survival were analyzed. In total, 119 patients were included, 74% of whom were females. The mean age was 44.2 years at the time of cancer diagnosis and 46.6 years at the time between NM diagnosis. Primary cancers were mostly breast cancer, lung cancer, or hematologic malignancies. The mean Karnofsky performance score (KPS) was 65. Frequent clinical symptoms were visual complaints, headache, cranial neuropathy, focal weakness, and decreased awareness. Diagnosis was made based on clinical symptoms, cytological CSF analysis results, and/or magnetic resonance imaging findings. The median overall survival (OS) was 4 months (95% CI 2.48-5.52). Prognostic variables associated with a better OS were hematopoietic malignancies, KPS ≥ 70, absence of meningeal signs, receiving any form of treatment, normal CSF glucose levels, and normal CSF LDH levels. After bivariate analysis, high LDH in the CSF remained statistically significant as a poor prognostic indicator. The LDH level is a useful parameter to assess the prognosis of patients with NM. Other factors associated with the prognosis of these patients were tumor type, CSF glucose levels, performance status, and receiving any form of treatment.
本研究旨在确定乳酸脱氢酶（LDH）水平在肿瘤性脑膜炎（NM）患者脑脊液（CSF）中的预后价值。纳入在癌症转诊中心确诊为NM的患者。分析了人口统计学和肿瘤学背景、临床症状、诊断检查、治疗及生存数据。共纳入119例患者，其中74%为女性。癌症诊断时的平均年龄为44.2岁，NM诊断时的平均年龄为46.6岁。原发癌主要为乳腺癌、肺癌或血液系统恶性肿瘤。卡诺夫斯基功能状态评分（KPS）平均为65分。常见临床症状为视觉障碍、头痛、颅神经病变、局灶性无力和意识减退。根据临床症状、脑脊液细胞学分析结果和/或磁共振成像结果进行诊断。中位总生存期（OS）为4个月（95%CI 2.48 - 5.52）。与较好OS相关的预后变量包括血液系统恶性肿瘤、KPS≥70、无脑膜刺激征、接受任何形式治疗、脑脊液葡萄糖水平正常和脑脊液LDH水平正常。经双变量分析后，脑脊液中高LDH作为不良预后指标仍具有统计学意义。LDH水平是评估NM患者预后的有用参数。与这些患者预后相关的其他因素包括肿瘤类型、脑脊液葡萄糖水平、功能状态和接受任何形式治疗。
