Factors Linked to Prognosis in Patients with Leptomeningeal Metastasis Diagnosed by Spinal Magnetic Resonance Imaging.
cervical cord lesion
intrathecal chemotherapy
leptomeningeal metastasis
paralysis
performance status
spinal MRI
Journal
Spine surgery and related research
ISSN: 2432-261X
Titre abrégé: Spine Surg Relat Res
Pays: Japan
ID NLM: 101718059
Informations de publication
Date de publication:
2020
2020
Historique:
received:
24
07
2019
accepted:
26
09
2019
entrez:
11
2
2020
pubmed:
11
2
2020
medline:
11
2
2020
Statut:
epublish
Résumé
Leptomeningeal metastasis (LM) is known to demonstrate a very poor prognosis. The purpose of this study was to evaluate the prognostic factors in LM cases diagnosed by spinal magnetic resonance imaging (MRI). We retrospectively analyzed 19 patients with LM detected by spinal MRI between 2010 and 2017. The primary tumors were breast carcinoma (n = 7), lung carcinoma (n = 6), lymphoma (n = 3), colorectal carcinoma (n = 2), and gastric carcinoma (n = 1). Thirteen patients exhibited preceding brain metastasis, and 11 of these exhibited metastasis in the posterior fossa. Ten patients exhibited limb paralysis. Performance status at diagnosis was 0-1 in 6 patients, 2 in 9 patients, and 3-4 in 4 patients. Testing of cerebrospinal fluid revealed malignant cells in 9 patients. On MRI, 11 patients demonstrated disseminated tumor lesions at the cervical cord level, 15 patients at the thoracic cord level, and 11 patients below the conus level. Eleven patients received radiation therapy, while intrathecal chemotherapy was performed in 9 patients. Univariate analysis revealed cervical cord level lesions, intrathecal chemotherapy, paralysis, and performance status as prognostic factors. Multivariate analysis identified existence of a cervical cord lesion as associated with a poor prognosis (hazards ratio (HR) 3.46, 95% confidence interval (CI) 1.12-12.2), while administration of intrathecal chemotherapy was associated with a good prognosis (HR 0.15, 95% CI 0.026-0.67). In LM patients, cervical cord level lesions are a negative factor for prognosis, and performance of intrathecal chemotherapy is a positive factor for prognosis.
Identifiants
pubmed: 32039299
doi: 10.22603/ssrr.2019-0064
pmc: PMC7002071
doi:
Types de publication
Journal Article
Langues
eng
Pagination
64-68Informations de copyright
Copyright © 2020 by The Japanese Society for Spine Surgery and Related Research.
Déclaration de conflit d'intérêts
Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.
Références
Surg Neurol Int. 2013 May 02;4(Suppl 4):S265-88
pubmed: 23717798
Cancer. 1994 Dec 15;74(12):3135-41
pubmed: 7982179
Eur J Cancer. 2016 Mar;56:107-114
pubmed: 26841095
Neuropathology. 2008 Jun;28(3):295-302
pubmed: 18179410
J Neurooncol. 2005 Oct;75(1):85-99
pubmed: 16215819
J Neurooncol. 2009 Jun;93(2):205-12
pubmed: 19043775
Handb Clin Neurol. 2018;149:169-204
pubmed: 29307353
Neurosurgery. 2013 Dec;73(6):923-31; discussion 932
pubmed: 23921711
Neuro Oncol. 2014 Sep;16(9):1176-85
pubmed: 24867803
Oncology. 1987;44(4):232-6
pubmed: 3039433
Semin Oncol. 2009 Aug;36(4 Suppl 2):S35-45
pubmed: 19660682
Cancer. 1998 Feb 15;82(4):733-9
pubmed: 9477107
J Neurosurg. 1996 Aug;85(2):225-30
pubmed: 8755750
J Cancer Res Clin Oncol. 2010 Nov;136(11):1729-35
pubmed: 20204406