Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
Thorac Cancer. 2022 Apr;13(7):1059-1066. doi: 10.1111/1759-7714.14362. Epub 2022 Mar 3.
To investigate the prognostic value of magnetic resonance imaging (MRI) findings in the prognosis of patients with leptomeningeal metastasis from lung adenocarcinoma.
Patients with lung adenocarcinoma complicated with cytologically confirmed leptomeningeal metastasis who visited Peking Union Medical College Hospital (blinded for review) between January 2012 and July 2019 were retrospectively reviewed. We collected the patients' clinical and neuroimaging findings and pathological data. The presence of leptomeningeal enhancement on initial contrast MRI was used to divide patients into MRI-positive and MRI-negative groups. Univariate and multivariate analyses were performed to evaluate prognostic factors.
Eighty-six patients (38 men and 48 women; median age = 56 [range, 25-80]) were included. Seventy-three patients (84.9%) had targetable genetic alterations. Only 30 patients (34.88%) had leptomeningeal enhancement on initial contrast MRI. No significant differences were observed in the distribution of demographics, driver gene status, intracranial pressure, complicated brain/spinal metastasis, or treatment strategies between the two groups. The median overall survival of patients in the MRI-positive group was significantly shorter than that in the negative group (182 days vs. 352 days, p = 0.036). Cox regression analysis indicated that the presence of leptomeningeal enhancement on the initial diagnostic magnetic resonance imaging was an independent predictor of an unfavourable prognosis of leptomeningeal metastasis (hazard ratio = 1.707, p = 0.044).
This is the first time that positive initial contrast-enhanced magnetic resonance imaging of the neuroaxis has been proposed as a risk factor for the prognosis of leptomeningeal metastasis from lung adenocarcinoma with contemporary survival data.
探讨磁共振成像（MRI）检查结果在肺腺癌脑膜转移患者预后中的预测价值。
回顾性分析 2012 年 1 月至 2019 年 7 月期间北京协和医院就诊的经细胞学证实合并脑膜转移的肺腺癌患者的临床和神经影像学资料。根据初诊 MRI 是否存在脑膜强化，将患者分为 MRI 阳性组和 MRI 阴性组。采用单因素和多因素分析评估预后因素。
共纳入 86 例患者（男 38 例，女 48 例；中位年龄 56 岁[范围 25~80 岁]）。73 例（84.9%）患者存在可靶向的基因改变。仅 30 例（34.88%）患者初诊 MRI 存在脑膜强化。两组患者在人口统计学特征、驱动基因状态、颅内压、合并脑/脊髓转移、治疗策略等方面差异无统计学意义。MRI 阳性组患者的总生存时间明显短于 MRI 阴性组（182 天比 352 天，p=0.036）。Cox 回归分析表明，初诊 MRI 存在脑膜强化是脑膜转移不良预后的独立预测因素（危险比 1.707，p=0.044）。
本研究首次提出，初诊时增强 MRI 显示脑脊髓轴阳性是肺腺癌脑膜转移患者生存时间的预测因素。
