The natural history of extracranial metastasis from glioblastoma multiforme
The natural history of extracranial metastasis from glioblastoma multiforme
复制标题
DOI：
10.1007/s11060-011-0575-8
复制
发表时间：
2011-11-01
影响因子：
3.9
通讯作者：
Wong, Eric T.
中科院分区：
文献类型：
--
作者：
Lun, Melody;Lok, Edwin;Wong, Eric T.
颅外转移是多形性胶质母细胞瘤的一种独特而罕见的表现。它被认为是由胶质母细胞瘤细胞扩散到血流中引起的。我们对1928年至2009年期间发表的88例颅外胶质母细胞瘤（5例为胶质瘤）进行了全面分析。分析中包括的病例是原发性或继发性胶质母细胞瘤，随后侵入脑或脊髓以外的器官。中位年龄为38岁，中位总生存时间为10.5个月（范围0.0-60.0个月）。从症状出现到诊断为原发性胶质母细胞瘤的中位时间为2.5个月，从诊断到发现颅外转移的中位时间为8.5个月，从转移到死亡的中位时间为1.5个月。从1940年到2009年，从检测到颅外转移到死亡的时间间隔逐渐延长，每十年0.7个月（95%置信区间0.5-1.0个月）。磁共振成像的使用与总生存率的增加相关，但与年龄、性别或原发性胶质母细胞瘤的部位无关。与单纯手术、单纯放疗、手术+放疗和手术+放疗+化疗治疗的患者相比，手术+放疗+化疗+脑脊液分流治疗的患者从转移到死亡的平均生存期最长。肺转移是预后极差的预后因素。我们的结论是，胶质母细胞瘤颅外转移的患者预后不良，但在1940年至2000年的每一个连续十年中，生存期都在逐步延长。
Extracranial metastasis is a unique but rare manifestation of glioblastoma multiforme. It is thought to arise from glioblastoma cells disseminated into the blood stream. We undertook a comprehensive analysis of 88 cases of extracranial glioblastoma (5 were gliosarcomas) published between 1928 and 2009. Cases included in the analysis were primary or secondary glioblastomas that subsequently invaded organs outside the brain or spinal cord. The median age was 38 years and the median overall survival time was 10.5 months (range 0.0-60.0 months). The median time from symptom onset to diagnosis of primary glioblastoma was 2.5 months, from diagnosis to detection of extracranial metastasis was 8.5 months, and from metastasis to death was 1.5 months. From 1940 to 2009, there has been progressive lengthening of the interval from detection of extracranial metastasis to death, at a rate of 0.7 months per decade (95% confidence interval 0.5-1.0 month). Use of magnetic resonance imaging correlates with an increase in overall survival but not age, gender, or site of primary glioblastoma. Patients treated with surgery + radiation + chemotherapy + cerebrospinal fluid shunting had the longest average survival interval from metastasis to death when compared to those treated with surgery alone, radiation alone, surgery + radiation, and surgery + radiation + chemotherapy. Lung metastasis is a prognostic factor of extremely poor outcomes. We conclude that patients with glioblastoma extracranial metastasis have poor prognosis, but there has been a progressive lengthening of survival in each successive decade from 1940 to 2000.