Cytologically proven leptomeningeal carcinomatosis in gastric cancer patients: Experience in a tertiary referral center

IF 0.3 Q4 GASTROENTEROLOGY & HEPATOLOGY
Chen-Ya Kuo, Wei-Yuan Chang, Ming-Tsan Lin, Chia-Tung Shun, Shang-Jie Tsai, Chin-Hao Chang, Tsu-Yao Cheng
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Abstract

Leptomeningeal carcinomatosis (LMC) is a rare but devastating complication of advanced cancer. The reported incidence may be underestimated because of the non-specific clinical presentation and the suboptimal accuracy of the confirmation tests. Despite advances in multidisciplinary care, the prognosis for patients with LMC remains poor. Gastric cancer (GC) ranking 9th in incidence among all kinds of malignancies in Taiwan. We aimed to review our experience with LMC in GC patients at a tertiary referral center to analyze the clinical features and survival outcomes. All patients with a malignant diagnosis of cerebrospinal fluid (CSF) cytology at the National Taiwan University Hospital were reviewed from January 2002 to December 2018. The survival analysis was calculated by the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards regression analysis were used to identify factors associated with survival. We identified 18 patients with a diagnosis of GC-related LMC. LMC occurred in approximately 0.45% of GC patients during this period. Nine (50%) were male, and the median age was 58.5 years old. The most frequent neurological symptom of these patients was altered mental status (72.2%), followed by headache (44.4%) and nausea/vomiting (44.4%). Intracranial hypertension was noted in 87.5% with the mean opening pressure to be 385.3 mmCSF. Intrathecal (IT) chemotherapy was administered to nine patients, principally with methotrexate alone (55.6%). Fourteen patients received CSF drainage by ventriculo-peritoneal shunt or external ventricular drainage via Ommaya reservoir for relieving intracranial hypertension. In the univariate Cox proportional hazards regression analysis, the poor ECOG performance status (>2), absence of other metastases, and absence of CSF drainage were all prognostic factors of poor survival. In conclusion, LMC was a rare manifestation of GC and was associated with an extremely poor survival when the performance status was poor at presentation. CSF drainage may have some impact on the survival duration in selected cases with LMC.

Abstract Image

细胞学证实的胃癌患者脑膜轻癌:三级转诊中心的经验
脑膜癌肿(LMC)是晚期癌症的一种罕见但具有破坏性的并发症。由于其临床表现无特异性,且确诊检查的准确性不高,因此报告的发病率可能被低估。尽管多学科治疗取得了进展,但 LMC 患者的预后仍然很差。在台湾,胃癌(GC)的发病率在各种恶性肿瘤中排名第九。我们旨在回顾我们在一家三级转诊中心治疗胃癌患者 LMC 的经验,分析其临床特征和生存结果。我们回顾了 2002 年 1 月至 2018 年 12 月期间台大医院所有经脑脊液(CSF)细胞学确诊为恶性肿瘤的患者。生存率分析采用 Kaplan-Meier 法计算。采用单变量和多变量 Cox 比例危险回归分析来确定与生存相关的因素。我们确定了 18 名确诊为 GC 相关 LMC 的患者。在此期间,约有 0.45% 的 GC 患者发生了 LMC。九名患者(50%)为男性,年龄中位数为 58.5 岁。这些患者最常见的神经系统症状是精神状态改变(72.2%),其次是头痛(44.4%)和恶心/呕吐(44.4%)。87.5%的患者出现颅内高压,平均开放压为385.3 mmCSF。9名患者接受了鞘内化疗,主要是单用甲氨蝶呤(55.6%)。14名患者通过脑室腹腔分流术或Ommaya储液器进行脑室外引流,以缓解颅内高压。在单变量 Cox 比例危险度回归分析中,ECOG 表现较差(>2)、无其他转移灶、无 CSF 引流均是生存率较低的预后因素。总之,LMC是GC的一种罕见表现,如果发病时表现状态较差,则生存率极低。CSF引流可能会对部分LMC病例的生存期产生一定影响。
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来源期刊
Advances in Digestive Medicine
Advances in Digestive Medicine GASTROENTEROLOGY & HEPATOLOGY-
自引率
33.30%
发文量
42
期刊介绍: Advances in Digestive Medicine is the official peer-reviewed journal of GEST, DEST and TASL. Missions of AIDM are to enhance the quality of patient care, to promote researches in gastroenterology, endoscopy and hepatology related fields, and to develop platforms for digestive science. Specific areas of interest are included, but not limited to: • Acid-related disease • Small intestinal disease • Digestive cancer • Diagnostic & therapeutic endoscopy • Enteral nutrition • Innovation in endoscopic technology • Functional GI • Hepatitis • GI images • Liver cirrhosis • Gut hormone • NASH • Helicobacter pylori • Cancer screening • IBD • Laparoscopic surgery • Infectious disease of digestive tract • Genetics and metabolic disorder • Microbiota • Regenerative medicine • Pancreaticobiliary disease • Guideline & consensus.
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