Clinical Features Of Meningeal Metastasis Of Lung Adenocarcinoma And Analysis Of Intrathecal Injection Of Methotrexate

Objective: Meningeal carcinomatosis refers to the diffuse or focal infiltration and metastasis of tumor cells along the meninges.Currently,the treatment is limited and there is no standard treatment.The purpose of this study was to analyze the clinical characteristics of patients with pulmonary adenocarcinoma complicated with meningeal carcinomatosis,to investigate the effects of intrathecal injection of Methotrexate(MTX)on the clinical symptoms,cerebrospinal fluid detection,intracranial pressure,imaging and survival of patients with meningeal carcinomatosis of lung adenocarcinoma,and to improve the understanding of this disease.Methods: Clinical data of 41 patients diagnosed with meningeal carcinomatosis of lung adenocarcinoma in the Fourth Hospital of Hebei Medical University from March 2015 to December 2019 were collected,including 23 cases treated with intrathecal injection of methotrexate,and the general data,clinical symptoms,imaging manifestations,cerebrospinal fluid,intracranial pressure and survival period of the patients were retrospectively analyzed.Log-rank test was used for univariate analysis,COX proportional regression model for multivariate analysis,and kaplan-meier method was used to draw the survival curve.Results: The age and clinical symptoms of 41 patients with meningeal carcinomatosis of lung adenocarcinoma were not specific,and headache and meningeal stimulation were the most common symptoms.A total of 40 cases completed skull enhancement MRI,and 8 cases indicated meningeal lesions,all of which were linear enhancement of the enhancement sequence.A total of 36 patients completed lumbar puncture,16 patients had increased CSF pressure,and all patients were positive for exfoliation cytology.After intrabasal injection of methotrexate,the neurological dysfunction was improved and the pain score(NRS score)was reduced,with statistically significant differences(P< 0.05).After intrathecal injection,the content of CSF protein decreased,and the difference was not statistically significant(P> 0.05),while the glucose content increased,and the difference was statistically significant(P< 0.05).The total survival time of the group receiving intrathecal injection of methotrexate was longer than that of the group not receiving intrathecal injection,and the difference was statistically significant(P< 0.05).COX multivariate analysis showed that intrathecal injection therapy was a protective factor to improve the prognosis of patients,and the combination of parenchymal metastasis was a risk factor to affect the prognosis of patients.Conclusions:1.The patients with meningeal carcinomatosis of lung adenocarcinoma are mostly middle-aged and elderly.Headache and meningeal stimulation are the most common clinical symptoms,and the specific symptoms are related to the nervous system regions involved in the metastasis;2.Patients with meningeal carcinomatosis of lung adenocarcinoma may have changes in cerebrospinal fluid,characterized by increased routine leukocytes in CSF,increased protein and decreased glucose,and an increase in cerebrospinal fluid pressure or not;3.Patients with meningeal carcinomatosis of lung adenocarcinoma without parenchymal metastasis have a longer survival time.Intrathecal injection of methotrexate can improve the quality of life and prolong the survival time of patients with meningeal carcinomatosis of lung adenocarcinoma.