高级别胶质瘤的脑膜播散：脑膜播散后的手术或辅助治疗是否与生存获益相关？
Leptomeningeal spread in high-grade gliomas: Is surgery or adjuvant therapy after leptomeningeal spread associated with survival benefit?
机构信息
Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
出版信息
Neurosurg Rev. 2023 Nov 23;46(1):311. doi: 10.1007/s10143-023-02209-8.
PURPOSE
This study aimed to identify prognostic factors associated with survival in patients with high-grade glioma (HGG) after leptomeningeal spread (LMS) and to clarify the behavior and treatment response.
METHODS
This retrospective study included 114 patients with HGGs diagnosed with LMS from August 1, 2014, to July 30, 2021, at our institution. Clinical, radiological, pathological, and outcome data were collected. Univariable and multivariable Cox regression were used for overall survival (OS) and post-LMS survival (PLS) analysis.
RESULTS
The median OS was 17.0 months and the median PLS was 6.0 months. Gross total resection (GTR) after LMS diagnosis and pathology grade III were statistically significantly associated with longer OS in all patients. GTR after LMS diagnosis and nodular LMS were independent favorable prognostic factors on PLS. Non-adjuvant therapy after LMS diagnosis was associated with shorter OS and PLS. In glioblastoma (GBM) subgroup analysis, GTR after LMS diagnosis and secondary LMS were independent favorable prognostic factors on OS. Karnofsky Performance Status (KPS) of ≥80 at LMS diagnosis, chemotherapy after LMS and intrathecal methotrexate (MTX) treatment were statistically significantly associated with longer PLS. MRI type II was a predictor of shorter PLS.
CONCLUSION
The treatment of patients with glioma after LMS diagnosis is very challenging and limited. Safe GTR of tumor and subsequent adjuvant therapy after LMS remains a powerful weapon to improve survival for HGG patients with LMS. Chemotherapy and Intrathecal MTX treatment are feasible treatments after LMS. The extent of tumor dissemination may affect the survival after LMS.
目的
本研究旨在确定高级别胶质瘤（HGG）患者发生脑膜播散（LMS）后的生存相关预后因素，并明确其行为和治疗反应。
方法
本回顾性研究纳入了 2014 年 8 月 1 日至 2021 年 7 月 30 日期间在我院诊断为 LMS 的 114 例 HGG 患者。收集了临床、影像学、病理学和结局数据。采用单变量和多变量 Cox 回归分析总生存（OS）和 LMS 后生存（PLS）。
结果
中位 OS 为 17.0 个月，中位 PLS 为 6.0 个月。LMS 诊断后的 GTR 和病理分级 III 与所有患者的 OS 延长具有统计学显著相关性。LMS 诊断后的 GTR 和结节性 LMS 是 PLS 的独立有利预后因素。LMS 诊断后非辅助治疗与 OS 和 PLS 缩短相关。在胶质母细胞瘤（GBM）亚组分析中，LMS 诊断后的 GTR 和继发性 LMS 是 OS 的独立有利预后因素。LMS 诊断时 Karnofsky 表现状态（KPS）≥80、LMS 后化疗和鞘内甲氨蝶呤（MTX）治疗与 PLS 延长具有统计学显著相关性。MRI 类型 II 是 PLS 缩短的预测因素。
结论
LMS 后对胶质瘤患者的治疗极具挑战性且有限。LMS 后安全地进行肿瘤 GTR 和随后的辅助治疗仍然是改善 LMS 高级别胶质瘤患者生存的有力武器。LMS 后化疗和鞘内 MTX 治疗是可行的治疗方法。肿瘤播散的程度可能影响 LMS 后的生存。
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