Revisiting prognostic factors in glioma with leptomeningeal metastases: a comprehensive analysis of clinical and molecular factors and treatment modalities.
Revisiting prognostic factors in glioma with leptomeningeal metastases: a comprehensive analysis of clinical and molecular factors and treatment modalities.
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DOI：
10.1007/s11060-022-04233-y
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发表时间：
2023-03
影响因子：
3.9
通讯作者：
Lee, Seung-Koo
中科院分区：
文献类型：
--
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
目的：全面研究成人脑胶质瘤合并软脑膜转移患者的预后因素，包括临床和分子因素及治疗方法。共纳入226例LM患者(2001年至2021年，在1495例2~4级胶质瘤患者中，88.5%的LM患者为IDH野生型)，对IDH突变、1p/19q共缺失和MGMT启动子甲基化状态有完整的了解。通过包括临床、分子和治疗数据在内的时间依赖的COX分析来确定整个患者总生存期(OS)的预测因素。对初诊的LM患者和复发时诊断的LM患者进行亚组分析(这里指的是初发和复发的LM)。在IDH-野生型胶质母细胞瘤患者中进行了相同的分析。中位OS为17.0(IQR9.7~67.1)个月，初发组中位OS较复发组短(12.2vs20.6个月，P <； 0.001)。在整个患者中，化疗和抗血管生成治疗是OS延长的预测因素，而男性和最初的LM是OS缩短的预测因素。在最初的LM中，较高的KPS、化疗和抗血管生成治疗是较长OS的预测因素，而男性是较短OS的预测因素。在复发的LM中，化疗和首次胶质瘤与LM诊断之间的间隔时间较长是OS延长的预测因素，而男性是OS较短的预测因素。IDH-野生型胶质母细胞瘤也有类似的趋势。积极的化疗和抗血管生成治疗对接受LM的脑胶质瘤患者的生存有好处。女性有始终如一的生存优势，而从最初的脑胶质瘤诊断到LM发展的较长间隔表明，复发的LM的OS更长。网上版载有补充材料，可在10.1007/s11060022-04233-y上查阅。
To comprehensively investigate prognostic factors, including clinical and molecular factors and treatment modalities, in adult glioma patients with leptomeningeal metastases (LM). Total 226 patients with LM (from 2001 to 2021 among 1495 grade 2 to 4 glioma patients, 88.5% of LM patients being IDH-wildtype) with complete information on IDH mutation, 1p/19q codeletion, and MGMT promoter methylation status were enrolled. Predictors of overall survival (OS) of entire patients were determined by time-dependent Cox analysis, including clinical, molecular, and treatment data. Subgroup analyses were performed for patients with LM at initial diagnosis and LM diagnosed at recurrence (herein, initial and recurrent LM). Identical analyses were performed in IDH-wildtype glioblastoma patients. Median OS was 17.0 (IQR 9.7–67.1) months, with shorter median OS in initial LM than recurrent LM patients (12.2 vs 20.6 months, P < 0.001). In entire patients, chemotherapy and antiangiogenic therapy were predictors of longer OS, while male sex and initial LM were predictors of shorter OS. In initial LM, higher KPS, chemotherapy, and antiangiogenic therapy were predictors of longer OS, while male sex was a predictor of shorter OS. In recurrent LM, chemotherapy and longer interval between initial glioma and LM diagnoses were predictors of longer OS, while male sex was a predictor of shorter OS. A similar trend was observed in IDH-wildtype glioblastoma. Active chemotherapy and antiangiogenic therapy demonstrated survival benefit in glioma patients with LM. There is consistent female survival advantage, whereas longer interval between initial glioma diagnosis and LM development suggests longer OS in recurrent LM. The online version contains supplementary material available at 10.1007/s11060-022-04233-y.
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