Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, USA.
Medicine (Baltimore). 2024 Jul 5;103(27):e38794. doi: 10.1097/MD.0000000000038794.
Extracranial metastases occur in <2% of cases of glioblastoma (GBM). When metastases do occur, bone is the most common destination. Herein, we review clinical characteristics of GBM patients with osseous metastases and evaluate both potential risk factors and prognostic significance.
Using an institutional database, we identified and retrospectively analyzed 6 patients with both GBM and osseous metastases. We collected data on patient demographics, tumor genetics, clinical courses, and outcomes. Given the rarity of metastatic GBM, we conducted historical comparisons using previously published literature.
Five patients with osseous metastases (83%) were male, with a median age of 46 years at GBM diagnosis (range: 20-84). All patients had IDH-wildtype, MGMT promoter unmethylated GBM and 5 (83%) had alterations in TP53. All patients underwent surgical resection for GBM followed by radiation with concurrent and adjuvant temozolomide. Four patients (67%) received bevacizumab prior to bone metastasis diagnosis. Bone metastases were discovered at a median of 12.2 months (range: 5.3-35.2) after GBM diagnosis and 4.8 months after starting bevacizumab (range: 3.5-13.2). Three patients (50%) received immunotherapy. After osseous metastasis diagnosis, the median survival was 25 days (range: 13-225).
In our cohort, most patients were male and young at the time of GBM diagnosis. All patients had IDH-wildtype, MGMT promoter unmethylated GBM, and most had alterations in TP53, which may be important for osseous metastasis. Most patients received bevacizumab, which has been associated with earlier metastasis. Osseous metastases of GBM occur and portend a dismal prognosis in an already aggressive malignancy.
颅外转移发生在<2%的胶质母细胞瘤（GBM）病例中。当转移确实发生时，骨骼是最常见的转移部位。在此，我们回顾了有骨转移的 GBM 患者的临床特征，并评估了潜在的危险因素和预后意义。
我们使用机构数据库，确定并回顾性分析了 6 名既有 GBM 又有骨转移的患者。我们收集了患者人口统计学、肿瘤遗传学、临床过程和结果的数据。由于转移性 GBM 罕见，我们使用以前发表的文献进行了历史比较。
5 名有骨转移的患者（83%）为男性，GBM 诊断时的中位年龄为 46 岁（范围：20-84 岁）。所有患者均为 IDH 野生型、MGMT 启动子未甲基化的 GBM，5 名（83%）患者存在 TP53 改变。所有患者均接受了 GBM 的手术切除，随后进行了放疗，同时联合和辅助使用替莫唑胺。在诊断出骨转移之前，有 4 名患者（67%）接受了贝伐单抗治疗。骨转移在 GBM 诊断后中位时间 12.2 个月（范围：5.3-35.2）和开始使用贝伐单抗后 4.8 个月（范围：3.5-13.2）被发现。3 名患者（50%）接受了免疫治疗。在诊断出骨转移后，中位生存时间为 25 天（范围：13-225 天）。
在我们的队列中，大多数患者在 GBM 诊断时为男性且年轻。所有患者均为 IDH 野生型、MGMT 启动子未甲基化的 GBM，且大多数患者存在 TP53 改变，这可能与骨转移有关。大多数患者接受了贝伐单抗治疗，这与更早的转移有关。GBM 的骨转移发生并预示着在一种已经具有侵袭性的恶性肿瘤中预后不良。
