Cunha Marcelo Lemos Vieira da, Maldaun Marcos Vinicius Calfat
Postgraduation in Neurooncology, Teaching and Research Institute at Hospital Sirio-Libanês, São Paulo, SP.
Chairman of the Neurosurgery Department at Hospital Regional do Oeste, Chapecó, SC, Brasil.
Rev Assoc Med Bras (1992). 2019 Mar;65(3):424-433. doi: 10.1590/1806-9282.65.3.424. Epub 2019 Apr 11.
Extracranial metastases of glioblastoma multiforme (GBM) are rare due to the short survival experienced by the patients. Therefore, the natural history of GBM metastases remains elusive. The identification of clinical factors promoting GBM metastases may help elucidate the mechanisms of tumor cell invasion in the brain. The aims of this study were to perform a meta-analysis evaluating the survival, characteristics, prognostic factors, and predictors of treatment outcome in patients with metastatic GBM and describe a case of metastatic extracranial GBM.
We report the case of a patient diagnosed with GBM metastatic to the lungs and the results of a meta-analysis of 114 other cases of metastatic GBM identified through a MEDLINE and BIREME search.
The mean age of the patients was 38.2±16.1 years and 70.4% were male. The time elapsed between the identification of the metastasis and death was significantly increased in patients undergoing surgery (p=0.019), whereas the time from the diagnosis of the primary tumor to death was significantly increased in patients receiving radiation therapy (p=0.050). The time elapsed from metastasis to death and diagnosis to death was significantly longer in patients receiving chemotherapy (p<0.001 and p=0.027, respectively). The liver was the metastatic site associated with the shortest time elapsed from diagnosis to death (p=0.024).
In GBM, surgical resection is important in reducing the risk of metastasis, and chemotherapy and radiation therapy help to prolong survival in metastatic GBM. Metastases to the liver are associated with shorter survival compared with metastases to other sites.
由于多形性胶质母细胞瘤（GBM）患者的生存期较短，其颅外转移很少见。因此，GBM转移的自然病程仍不清楚。确定促进GBM转移的临床因素可能有助于阐明肿瘤细胞在脑内侵袭的机制。本研究的目的是进行一项荟萃分析，评估转移性GBM患者的生存期、特征、预后因素和治疗结果预测因素，并描述一例颅外转移性GBM病例。
我们报告一例被诊断为GBM肺转移的患者病例，以及通过MEDLINE和BIREME检索确定的其他114例转移性GBM病例的荟萃分析结果。
患者的平均年龄为38.2±16.1岁，70.4%为男性。接受手术的患者从转移确诊到死亡的时间显著延长（p=0.019），而接受放射治疗的患者从原发性肿瘤诊断到死亡的时间显著延长（p=0.050）。接受化疗的患者从转移到死亡和从诊断到死亡的时间显著更长（分别为p<0.001和p=0.027）。肝脏是从诊断到死亡时间最短的转移部位（p=0.024）。
在GBM中，手术切除对于降低转移风险很重要，化疗和放射治疗有助于延长转移性GBM患者的生存期。与转移到其他部位相比，转移到肝脏与较短的生存期相关。
