The prognostic significance of surgically treated hydrocephalus in leptomeningeal metastases
The prognostic significance of surgically treated hydrocephalus in leptomeningeal metastases
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DOI：
10.1016/j.clineuro.2014.01.023
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发表时间：
2014-04-01
影响因子：
1.9
通讯作者：
Oh, In-Jae
中科院分区：
文献类型：
--
作者：
Jung, Tae-Young;Chung, Woong-Ki;Oh, In-Jae
目的：脑膜轻脑膜转移瘤的中位生存期较短，尽管治疗，有时与脑积水有关。我们探讨脑膜轻脑膜转移性脑积水手术治疗的预后意义。材料与方法：2005年12月至2012年11月，1343例系统性实体瘤脑转移患者。其中，71例（5.3%）患者发生了45例肺癌、14例乳腺癌、4例胃癌和8例其他癌症的脑膜轻脑膜转移。平均年龄60岁（37 ~ 89岁）。临床症状表现为大脑半球及小脑58例，颅神经7例，脊髓及神经6例。放射治疗肿瘤组递归划分分析（RTOG-RPA） II类29例（40.8%），III类42例（59.2%）。18例（25.4%）伴有脑积水，7例行脑室-腹膜分流术。分析原发性肿瘤、临床症状、RTOG-RPA分级、手术治疗的脑积水及全身化疗作为影响总生存的预后因素。结果：脑转移瘤的总发生率为5.0%。脑膜转移的中位持续时间为4.0个月，24例（33.8%）患者以脑膜转移为脑转移的第一形式。中位总生存期（OS）为2.1个月。基于单因素和多因素分析，RTOG-RPA II类患者、轻脑膜转移治疗（如放疗或鞘内化疗）和全身化疗对OS的改善具有统计学意义。未手术治疗的脑积水（中位OS为1.7个月）的OS较手术治疗的脑积水（中位OS为5.7个月）和未手术治疗的脑积水（中位OS为2.3个月）的OS差，但无统计学意义。结论：脑膜轻脑膜转移常伴有脑积水，手术治疗对部分患者有帮助。预后与RTOG-RPA分级及局部及全身治疗有关。(C) 2014年作者。Elsevier B.V.版权所有。
Objective: The median survival of leptomeningeal metastases is short despite therapy and is sometime associated with hydrocephalus. We investigated the prognostic significance of surgically treated hydrocephalus in leptomeningeal metastases.Materials and methods: Between December 2005 and November 2012, 1343 patients had brain metastases from systemic solid tumors. Of these, 71 patients (5.3%) experienced leptomeningeal metastases from 45 lung cancers, 14 breast cancers, 4 gastric cancers and 8 other cancers. The mean age was 60 years (range 37-89). The clinical symptoms presented in the cerebral hemisphere and cerebellum in 58 patients, cranial nerve in 7 patients and spinal cord and nerves in 6 patients. Twenty-nine (40.8%) patients were Radiation Therapy Oncology Group recursive partitioning analysis (RTOG-RPA) class II and 42 (59.2%) were class III. Hydrocephalus was associated in 18 (25.4%) patients and 7 patients underwent ventriculoperioneal shunt. The primary cancer, clinical symptoms, RTOG-RPA class, surgically treated hydrocephalus and systemic chemotherapy were analyzed as the prognostic factors for overall survival.Results: The overall incidence of leptomeningeal seeding was 5.0% of the brain metastases. The median duration of leptomeningeal metastases from first brain metastasis was 4.0 months and 24(33.8%) patients showed leptomeningeal metastases as the first form of brain metastasis. The median overall survival (OS) was 2.1 months. Based on the univariate and multivariate analyses, RTOG-RPA class II patients, treatment of leptomeningeal metastases (such as radiotherapy or intrathecal chemotherapy) and systemic chemotherapy improved OS with statistical significance. Surgically untreated hydrocephalus (median OS, 1.7 months) showed poor OS compared with surgically treated hydrocephalus (median OS, 5.7 months) and no hydrocephalus (median OS, 2.3 months) without statistical significance.Conclusions: The leptomeningeal metastases were often associated with hydrocephalus and the surgical treatment was helpful in limited patients. The prognosis was related with RTOG-RPA class and treatment of local and systemic treatment. (C) 2014 The Authors. Published by Elsevier B.V. All rights reserved.