Leptomeningeal spread in high-grade gliomas: Is surgery or adjuvant therapy after leptomeningeal spread associated with survival benefit?
Leptomeningeal spread in high-grade gliomas: Is surgery or adjuvant therapy after leptomeningeal spread associated with survival benefit?
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DOI：
10.1007/s10143-023-02209-8
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发表时间：
2023-11-23
影响因子：
2.8
通讯作者：
Li, Shouwei
中科院分区：
文献类型：
--
作者：
Zhong, Shuai;Fu, Xiaojun;Wu, Chenxing;Liu, Rui;Li, Shouwei
本研究旨在确定轻脑膜扩散（LMS）后高级别胶质瘤（HGG）患者生存相关的预后因素，并阐明其行为和治疗反应。本回顾性研究纳入了2014年8月1日至2021年7月30日在我院诊断为LMS的114例hgg患者。收集临床、放射学、病理和结局资料。采用单变量和多变量Cox回归进行总生存期（OS）和lms后生存期（PLS）分析。中位OS为17.0个月，中位PLS为6.0个月。在所有患者中，LMS诊断后的总切除（GTR）和病理分级III与较长的生存期有统计学显著相关。LMS诊断后GTR和结节性LMS是独立的预后有利因素，LMS诊断后非辅助治疗与较短的OS和PLS相关，在胶质母细胞瘤（GBM）亚组分析中，LMS诊断后GTR和继发性LMS是独立的预后有利因素。LMS诊断时Karnofsky Performance Status (KPS)≥80，LMS后化疗和鞘内甲氨蝶呤（MTX）治疗与PLS延长有统计学意义相关，MRI II型预测LMS后胶质瘤患者的治疗非常具有挑战性和局限性。LMS后安全的肿瘤GTR和后续的辅助治疗仍然是提高HGG合并LMS患者生存率的有力武器。化疗和鞘内MTX治疗是LMS后可行的治疗方法。肿瘤播散程度可能影响LMS后的生存。
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. 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. 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. 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.
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影响因子：
158.5
作者：
Stupp, R;Mason, WP;Ryan, G
通讯作者：
Ryan, G
影响因子：
3.9
作者：
Park, Yae Won;Han, Kyunghwa;Kim, Sooyon;Kwon, Hyuk;Ahn, Sung Soo;Moon, Ju Hyung;Kim, Eui Hyun;Kim, Jinna;Kang, Seok-Gu;Chang, Jong Hee;Kim, Se Hoon;Lee, Seung-Koo
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Lee, Seung-Koo
影响因子：
15.9
作者：
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通讯作者：
Jaeckle, Kurt A.
影响因子：
3.9
作者：
Battista, Francesca;Muscas, Giovanni;Dinoi, Francesca;Gadda, Davide;Della Puppa, Alessandro
通讯作者：
Della Puppa, Alessandro
影响因子：
2.4
作者：
Noh, Jung-Hoon;Lee, Min Ho;Seol, Ho Jun
通讯作者：
Seol, Ho Jun