Blazquez Raquel, Proescholdt Martin Andreas, Klauser Marlene, Schebesch Karl-Michael, Doenitz Christian, Heudobler Daniel, Stange Lena, Riemenschneider Markus J, Bumes Elisabeth, Rosengarth Katharina, Schicho Andreas, Schmidt Nils-Ole, Brawanski Alexander, Pukrop Tobias, Wendl Christina
Department of Internal Medicine III, Hematology and Medical Oncology, University Hospital Regensburg, Regensburg, Germany.
Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany.
Front Oncol. 2022 Apr 4;12:849880. doi: 10.3389/fonc.2022.849880. eCollection 2022.
Brain metastases (BM) can present a displacing or infiltrating growth pattern, independent of the primary tumor type. Previous studies have shown that tumor cell infiltration at the macro-metastasis/brain parenchyma interface (MMPI) is correlated with poor outcome. Therefore, a pre-therapeutic, non-invasive detection tool for potential metastatic cell infiltration at the MMPI would be desirable to help identify patients who may benefit from a more aggressive local treatment strategy. The aim of this study was to identify specific magnetic resonance imaging (MRI) patterns at the MMPI in patients with BM and to correlate these patterns with patient outcome.
In this retrospective analysis of a prospective BM registry, we categorized preoperative MR images of 261 patients with BM according to a prespecified analysis system, which consisted of four MRI contrast enhancement (CE) patterns: two with apparently regularly shaped borders (termed "rim-enhancing" and "spherical") and two with irregular delineation (termed "breakout" and "diffuse"). The primary outcome parameter was overall survival (OS). Additionally analyzed prognostic parameters were the Karnofsky Performance Index, tumor size, edema formation, extent of resection, and RPA class.
OS of patients with a breakout pattern was significantly worse than OS of all other groups.
Our data show that BM with a breakout pattern have a highly aggressive clinical course. Patients with such a pattern potentially require a more aggressive local and systemic treatment strategy.
脑转移瘤（BM）可呈现推挤性或浸润性生长模式，与原发肿瘤类型无关。既往研究表明，在宏观转移灶/脑实质界面（MMPI）处的肿瘤细胞浸润与预后不良相关。因此，一种用于在MMPI处检测潜在转移细胞浸润的治疗前非侵入性检测工具，将有助于识别可能从更积极的局部治疗策略中获益的患者。本研究的目的是识别BM患者MMPI处的特定磁共振成像（MRI）模式，并将这些模式与患者预后相关联。
在这项对前瞻性BM登记处的回顾性分析中，我们根据一个预先指定的分析系统，对261例BM患者的术前MR图像进行分类，该系统包括四种MRI对比增强（CE）模式：两种边界明显规则（称为“边缘强化”和“球形”），两种边界不规则（称为“突破”和“弥漫”）。主要结局参数为总生存期（OS）。另外分析的预后参数包括卡氏功能状态评分、肿瘤大小、水肿形成、切除范围和RPA分级。
具有突破模式的患者的OS显著差于所有其他组。
我们的数据表明，具有突破模式的BM具有高度侵袭性的临床病程。具有这种模式的患者可能需要更积极的局部和全身治疗策略。
