Clinical Features And Prognostic Factors In Patients With Leptomeningeal Metastases

Objectives Leptomeningeal metastases refers to the dissemination of malignant cells to the pia and arachnoid mater(the leptomeninges) and the subarachnoid space, which contains cerebrospinal fluid. The incidence of LM from various tumors is rising in recent years, likely due to improved systemic treatments and diagnostic testing. The purpose of this retrospective study is to evaluate clinical features, treatment patterns, prognostic factors.Methods Medical records of 98 patients with LM from January 1, 2005 to January 1, 2015 were retrospectively reviewed in Tianjin Medical University Cancer Institute and Hospital. Statistical analyses were performed using the SPSS18.0 software. Survival curves were estimated using the Kaplan–Meier method. Differences in survival between groups were tested using the Log-rank test. A Cox proportional hazards model was used to evaluate prognostic factors associated with improved survival.Results 1. Characteristics of the patients with LMA total of 98 patients were included in this study, including 35 males and 63 females. Median age at diagnosis was 55 years. Median KPS score was 80 points. The primary tumor included lung cancer lung cancer(n=64), breast cancer(n=18), gastric cancer(n=3), laryngeal cancer(n=1), non-Hodgkin lymphoma(n=1), Hodgkin lymphoma(n=1), malignant melanoma(n=1), primitive neuroectodermal tumor(n=1), bladder cancer(n=1), endometrial carcinoma(n=1), oophoroma(n=1), carcinoma of fallopian tube(n=1), glioma(n=1), 2 cases of primary tumors was undefined. 93 patients had been documented as having neurological symptoms. Presenting symptoms of LM were categorized into three subgroups; symptoms suggestive of the involvement of the cerebrum, spinal cord or cranial nerve. Among cerebral involvement symptoms, headache was most common with 73 patients followed by nausea or vomiting in 46 patients. 17 patients had meningeal irritation sign. 20 patients had symptoms of the cranial nerve involvement such as diplopia, visual disturbance, hearing disorder and so on. Among 18 patients presented with spinal involvement symptoms, weakness of extremities was most common manifestation. 5 patients had bowel/bladder dysfunction. 12 patients had epilepsy. 7 patients had ataxia.2. Survival and prognosis of the patients with LMThe median survival time for all the patients was 5.0 months. The 1-year overall survival rate was 21.4%. Univariate analysis revealed that KPS score, local chemotherapy, systemic treatment, systeminc chemotherapy, treatment methods and treatment responsewere related to the prognosis(P < 0.05). EGFR-TKI therapy improved the outcomes of LM in lung cancer patients(P=0.007). Multivariate analysis indicated that KPS score, systemic treatment and treatment response were the independent prognostic factors.ConclusionsLM remains a devastating complication of cancer that typically occurs at a late stage of disease. The classic presentation is with multifocal neurologic signs and symptoms, many patients also have manifestation of hydrocephalus. KPS score, treatment response are the independent prognostic factors for LM. Systemic treatment is significantly associated with longer survival time.