Ammendola Serena, Barresi Valeria, Bariani Elena, Girolami Ilaria, D'Errico Antonia, Brunelli Matteo, Cardillo Massimo, Lombardini Letizia, Carraro Amedeo, Boggi Ugo, Cain Owen, Neil Desley, Eccher Albino
Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy.
Division of Pathology, Central Hospital, Bolzano 39100, Italy.
World J Transplant. 2022 Jun 18;12(6):131-141. doi: 10.5500/wjt.v12.i6.131.
Patients with a history of primary brain tumors can be eligible for organ donation under extended criteria. The risk assessment of tumor transmission organ transplant in primary brain tumors is primarily based on the assessment of tumor histotype and grade. Previous surgeries, chemo-/radiotherapy, and ventriculo-peritoneal shunt placement can lead to a disruption of the blood-brain barrier, concurring to an increase in the transmission risk.
To investigate the role of tumor transmission risk factors in donors with oligodendrogliomas and astrocytomas.
We searched PubMed and EMBASE databases for studies reporting extraneural spreading of oligodendrogliomas and astrocytomas and extracted clinical-pathological data on the primary tumor histotype and grade, the elapsed time from the diagnosis to the onset of metastases, sites and number of metastases, prior surgeries, prior radiotherapy and/or chemotherapy, ventriculo-atrial or ventriculo-peritoneal shunt placement, and the presence of isocitrate dehydrogenase 1/2 mutation and 1p/19q codeletion. Statistical analysis was performed using R software. Statistical correlation between chemotherapy or radiotherapy and the presence of multiple extra-central nervous system metastases was analyzed using and Fischer exact test. The Kaplan-Meier method was used to evaluate the presence of a correlation between the metastasis-free time and: (1) Localization of metastases; (2) The occurrence of intracranial recurrences; and (3) The occurrence of multiple metastases.
Data on a total of 157 patients were retrieved. The time from the initial diagnosis to metastatic spread ranged from 0 to 325 mo in patients with oligodendrogliomas and 0 to 267 mo in those with astrocytomas. Respectively, 19% and 39% of patients with oligodendroglioma and astrocytoma did not receive any adjuvant therapy. The most frequent metastatic sites were bone, bone marrow, and lymph nodes. The lungs and the liver were the most commonly involved visceral sites. There was no significant correlation between the occurrence of multiple metastases and the administration of adjuvant chemo-/radiotherapy. Patients who developed intracranial recurrences/metastases had a significantly longer extraneural metastasis-free time compared to those who developed extraneural metastases in the absence of any intra- central nervous system spread.
A long follow-up time does not exclude the presence of extraneural metastases. Therefore, targeted imaging of bones and cervical lymph nodes may improve safety in the management of these donors.
有原发性脑肿瘤病史的患者在扩展标准下可符合器官捐赠条件。原发性脑肿瘤器官移植中肿瘤传播的风险评估主要基于肿瘤组织学类型和分级的评估。既往手术、化疗/放疗以及脑室-腹腔分流术的放置可导致血脑屏障破坏，增加传播风险。
探讨少突胶质细胞瘤和星形细胞瘤供体中肿瘤传播危险因素的作用。
我们在PubMed和EMBASE数据库中检索报告少突胶质细胞瘤和星形细胞瘤神经外扩散的研究，并提取关于原发性肿瘤组织学类型和分级、从诊断到转移发生的时间、转移部位和数量、既往手术、既往放疗和/或化疗、脑室-心房或脑室-腹腔分流术的放置以及异柠檬酸脱氢酶1/2突变和1p/19q共缺失情况的临床病理数据。使用R软件进行统计分析。使用卡方检验和费舍尔精确检验分析化疗或放疗与多个中枢神经系统外转移的存在之间的统计相关性。采用Kaplan-Meier方法评估无转移时间与以下因素之间的相关性：（1）转移部位；（2）颅内复发的发生；（3）多个转移的发生。
共检索到157例患者的数据。少突胶质细胞瘤患者从初始诊断到转移扩散的时间为0至325个月，星形细胞瘤患者为0至267个月。少突胶质细胞瘤和星形细胞瘤患者分别有19%和39%未接受任何辅助治疗。最常见的转移部位是骨、骨髓和淋巴结。肺和肝是最常受累的内脏部位。多个转移的发生与辅助化疗/放疗的应用之间无显著相关性。与未发生任何中枢神经系统内扩散而发生神经外转移的患者相比，发生颅内复发/转移的患者神经外无转移时间明显更长。
长时间随访并不能排除神经外转移的存在。因此，对骨骼和颈部淋巴结进行靶向成像可能会提高这些供体管理的安全性。
