Department of Neurology, University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt, Germany.
Neurol Sci. 2022 Sep;43(9):5513-5522. doi: 10.1007/s10072-022-06142-4. Epub 2022 May 19.
The concurrent presence of both central nervous system (CNS) tumors and multiple sclerosis (MS) poses various diagnostic and therapeutic pitfalls and makes the clinical management of such patients challenging.
In this retrospective, single-center cohort study, we searched our clinical databases (2006-2019) for patients with concurrent CNS tumors and MS and described their disease courses. Age at diagnosis of the respective disease and probabilities for MS disease activity events (DAEs) with vs. without prior tumor-specific therapy were tested pairwise using t-test for dependent samples and exact binomial test.
N = 16 patients with concurrent CNS tumors and MS were identified. MS diagnosis preceded the CNS oncological diagnosis by an average of 9 years (p = 0.004). More DAEs occurred in patients without prior chemotherapy (83.3%) than in patients with prior chemotherapy (16.7%; p = 0.008). This effect did not reach significance for patients with prior radiation therapy/radiosurgery (66.7% vs. 33.3%, p = 0.238). The average interval between DAEs and the last documented lymphopenia was 32.25 weeks.
This study describes the clinical and demographic features of patients with concurrent CNS tumors and MS and suggests several practical approaches to their clinical management. Our findings suggest that adding a disease-modifying MS therapy to the regimen of patients treated with chemotherapy is necessary only if the patient suffers from a highly active, aggressive course of MS. In view of the lack of prospective trials, individual risk assessments should remain the foundation of the decision on MS treatment in concurrent CNS tumor diseases.
中枢神经系统（CNS）肿瘤和多发性硬化症（MS）同时存在会带来各种诊断和治疗陷阱，使此类患者的临床管理具有挑战性。
在这项回顾性、单中心队列研究中，我们在我们的临床数据库（2006-2019 年）中搜索了同时患有 CNS 肿瘤和 MS 的患者，并描述了他们的疾病过程。使用配对样本 t 检验和精确二项式检验分别测试了各自疾病的诊断年龄和有无肿瘤特异性治疗的 MS 疾病活动事件（DAE）的概率。
共确定了 16 例同时患有 CNS 肿瘤和 MS 的患者。MS 诊断比 CNS 肿瘤诊断平均提前 9 年（p=0.004）。在无化疗的患者中发生的 DAE 更多（83.3%比 16.7%；p=0.008），而在有化疗的患者中则更少（16.7%比 83.3%；p=0.008）。对于有放疗/放射外科治疗的患者，这一效应无统计学意义（66.7%比 33.3%；p=0.238）。DAE 与最后一次记录的淋巴细胞减少之间的平均间隔为 32.25 周。
本研究描述了同时患有 CNS 肿瘤和 MS 的患者的临床和人口统计学特征，并提出了几种对其进行临床管理的实用方法。我们的研究结果表明，只有在患者患有高度活跃、侵袭性 MS 病程时，才需要在接受化疗的患者的治疗方案中添加一种治疗 MS 的疾病修饰药物。鉴于缺乏前瞻性试验，对 MS 治疗的决策仍应基于对患者个体风险的评估。
