机构：[1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China重点科室诊疗科室神经外科神经外科首都医科大学附属天坛医院[2]Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China职能科室医技科室药学部药学部/药剂科首都医科大学附属天坛医院[3]Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China重点科室医技科室放射科放射科首都医科大学附属天坛医院[4]Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China医技科室病理科首都医科大学附属天坛医院[5]National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brian Tumor, Beijing 100070, China
PurposeLeptomeningeal spread to the fourth ventricle (LSFV) from supratentorial high-grade astrocytoma (HGA) is rarely investigated. The incidence and prognostic merit of LSFV were analyzed in this study.MethodsA consecutive cohort of 175 patients with pathologically diagnosed HGA according to the 2016 WHO classification of brain tumors was enrolled. LSFV was defined as radiological occupation in the fourth ventricle at the moment of initial progression. Clinical, radiological, and pathological data were analyzed to explore the difference between HGA patients with and without LSFV.ResultsThere were 18 of 175 (10.3%) HGAs confirmed with LSFV. The difference of survival rate between patients with LSFV or not was significant in both overall survival (OS) (14.5 vs. 24months, P= 0.0007) and post progression survival (PPS) (6.0 vs. 11.5months, P = 0.0004), while no significant difference was observed in time to progression (TTP) (8.5 months vs. 9.5months P=0.6795). In the Cox multivariate analysis, LSFV was confirmed as an independent prognostic risk factor for OS (HR 2.06, P = 0.010). LSFV was correlated with younger age (P=0.044), ventricle infringement of primary tumor (P<0.001) and higher Ki-67 index (P = 0.013) in further analysis, and the latter two have been validated in the Logistic regression analysis (OR 18.16, P = 0.006; OR 4.04, P = 0.012, respectively).ConclusionLSFV was indicative of end-stage for supratentorial HGA patients, which shortened patients' PPS and OS instead of TTP. It's never too cautious to alert this lethal event when tumor harbored ventricle infringement and higher Ki-67 index in routine clinical course.
基金：
National Natural Science Foundation of ChinaNational Natural Science Foundation of China [81571632]
第一作者机构：[1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
通讯作者：
通讯机构：[1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China[5]National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brian Tumor, Beijing 100070, China
推荐引用方式(GB/T 7714)：
Li Mingxiao,Ren Xiaohui,Jiang Haihui,et al.Supratentorial high-grade astrocytoma with leptomeningeal spread to the fourth ventricle: a lethal dissemination with dismal prognosis[J].JOURNAL OF NEURO-ONCOLOGY.2019,142(2):253-261.doi:10.1007/s11060-018-03086-8.
APA：
Li, Mingxiao,Ren, Xiaohui,Jiang, Haihui,Yang, Kaiyuan,Huang, Wei...&Lin, Song.(2019).Supratentorial high-grade astrocytoma with leptomeningeal spread to the fourth ventricle: a lethal dissemination with dismal prognosis.JOURNAL OF NEURO-ONCOLOGY,142,(2)
MLA：
Li, Mingxiao,et al."Supratentorial high-grade astrocytoma with leptomeningeal spread to the fourth ventricle: a lethal dissemination with dismal prognosis".JOURNAL OF NEURO-ONCOLOGY 142..2(2019):253-261
