Kamoda Hiroto, Kinoshita Hideyuki, Yonemoto Tsukasa, Iuchi Toshihiko, Tsukanishi Toshinori, Hagiwara Yoko, Ohtori Seiji, Yamazaki Masashi, Ishii Takeshi
Division of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan.
Division of Neurological Surgery, Chiba Cancer Center, Chiba, Japan.
Spine Surg Relat Res. 2019 Nov 1;4(1):64-68. doi: 10.22603/ssrr.2019-0064. eCollection 2020.
Leptomeningeal metastasis (LM) is known to demonstrate a very poor prognosis. The purpose of this study was to evaluate the prognostic factors in LM cases diagnosed by spinal magnetic resonance imaging (MRI).
We retrospectively analyzed 19 patients with LM detected by spinal MRI between 2010 and 2017.
The primary tumors were breast carcinoma (n = 7), lung carcinoma (n = 6), lymphoma (n = 3), colorectal carcinoma (n = 2), and gastric carcinoma (n = 1). Thirteen patients exhibited preceding brain metastasis, and 11 of these exhibited metastasis in the posterior fossa. Ten patients exhibited limb paralysis. Performance status at diagnosis was 0-1 in 6 patients, 2 in 9 patients, and 3-4 in 4 patients. Testing of cerebrospinal fluid revealed malignant cells in 9 patients. On MRI, 11 patients demonstrated disseminated tumor lesions at the cervical cord level, 15 patients at the thoracic cord level, and 11 patients below the conus level. Eleven patients received radiation therapy, while intrathecal chemotherapy was performed in 9 patients. Univariate analysis revealed cervical cord level lesions, intrathecal chemotherapy, paralysis, and performance status as prognostic factors. Multivariate analysis identified existence of a cervical cord lesion as associated with a poor prognosis (hazards ratio (HR) 3.46, 95% confidence interval (CI) 1.12-12.2), while administration of intrathecal chemotherapy was associated with a good prognosis (HR 0.15, 95% CI 0.026-0.67).
In LM patients, cervical cord level lesions are a negative factor for prognosis, and performance of intrathecal chemotherapy is a positive factor for prognosis.
已知软脑膜转移（LM）的预后非常差。本研究的目的是评估经脊柱磁共振成像（MRI）诊断的LM病例的预后因素。
我们回顾性分析了2010年至2017年间经脊柱MRI检测出的19例LM患者。
原发肿瘤为乳腺癌（n = 7）、肺癌（n = 6）、淋巴瘤（n = 3）、结直肠癌（n = 2）和胃癌（n = 1）。13例患者先前有脑转移，其中11例在后颅窝有转移。10例患者出现肢体瘫痪。诊断时的体能状态为0 - 1分的有6例患者，2分的有9例患者，3 - 4分的有4例患者。脑脊液检查发现9例患者有恶性细胞。在MRI上，11例患者在颈髓水平有弥漫性肿瘤病变，15例患者在胸髓水平有病变，11例患者在圆锥以下水平有病变。11例患者接受了放射治疗，9例患者进行了鞘内化疗。单因素分析显示颈髓水平病变、鞘内化疗、瘫痪和体能状态为预后因素。多因素分析确定颈髓病变的存在与预后不良相关（风险比（HR）3.46，95%置信区间（CI）1.12 - 12.2），而鞘内化疗与预后良好相关（HR 0.15，95% CI 0.026 - 0.67）。
在LM患者中，颈髓水平病变是预后的负面因素，鞘内化疗的实施是预后的正面因素。
