Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
J Neurooncol. 2019 Apr;142(2):253-261. doi: 10.1007/s11060-018-03086-8. Epub 2019 Jan 2.
Leptomeningeal spread to the fourth ventricle (LSFV) from supratentorial high-grade astrocytoma (HGA) is rarely investigated. The incidence and prognostic merit of LSFV were analyzed in this study.
A consecutive cohort of 175 patients with pathologically diagnosed HGA according to the 2016 WHO classification of brain tumors was enrolled. LSFV was defined as radiological occupation in the fourth ventricle at the moment of initial progression. Clinical, radiological, and pathological data were analyzed to explore the difference between HGA patients with and without LSFV.
There were 18 of 175 (10.3%) HGAs confirmed with LSFV. The difference of survival rate between patients with LSFV or not was significant in both overall survival (OS) (14.5 vs. 24 months, P = 0.0007) and post progression survival (PPS) (6.0 vs. 11.5 months, P = 0.0004), while no significant difference was observed in time to progression (TTP) (8.5 months vs. 9.5 months P = 0.6795). In the Cox multivariate analysis, LSFV was confirmed as an independent prognostic risk factor for OS (HR 2.06, P = 0.010). LSFV was correlated with younger age (P = 0.044), ventricle infringement of primary tumor (P < 0.001) and higher Ki-67 index (P = 0.013) in further analysis, and the latter two have been validated in the Logistic regression analysis (OR 18.16, P = 0.006; OR 4.04, P = 0.012, respectively).
LSFV was indicative of end-stage for supratentorial HGA patients, which shortened patients' PPS and OS instead of TTP. It's never too cautious to alert this lethal event when tumor harbored ventricle infringement and higher Ki-67 index in routine clinical course.
幕上高级别星形细胞瘤（HGA）向第四脑室（LSFV）的脑膜播散很少被研究。本研究分析了 LSFV 的发生率和预后价值。
连续纳入了 175 名根据 2016 年世界卫生组织脑肿瘤分类病理诊断为 HGA 的患者。LSFV 定义为初始进展时第四脑室的影像学占位。分析临床、影像学和病理学数据，以探讨 HGA 患者中有无 LSFV 的差异。
175 例 HGA 中有 18 例（10.3%）证实存在 LSFV。LSFV 患者的总生存率（OS）（14.5 与 24 个月，P=0.0007）和进展后生存率（PPS）（6.0 与 11.5 个月，P=0.0004）差异有统计学意义，但无进展时间（TTP）（8.5 个月与 9.5 个月，P=0.6795）差异无统计学意义。在 Cox 多变量分析中，LSFV 被确认为 OS 的独立预后危险因素（HR 2.06，P=0.010）。进一步分析显示，LSFV 与年龄较小（P=0.044）、原发肿瘤侵犯脑室（P<0.001）和较高的 Ki-67 指数（P=0.013）相关，后两者在 Logistic 回归分析中得到验证（OR 18.16，P=0.006；OR 4.04，P=0.012）。
LSFV 提示幕上 HGA 患者处于终末期，缩短了患者的 PPS 和 OS，而不是 TTP。当肿瘤在常规临床过程中存在脑室侵犯和较高的 Ki-67 指数时，对这一致命事件发出警报，绝不过分。
