J Korean Neurosurg Soc.  2023 Jul;66(4):465-475. 10.3340/jkns.2022.0166.

Leptomeningeal Metastasis in Gliomas : Clinical Characteristics and Risk Factors

• Yang J
• Kwon JW
• Shin SH
• Yoo H
• Wang KC
• Lee SH
• Gwak HS

• KMID: 2543538
• DOI: http://doi.org/10.3340/jkns.2022.0166

Abstract

Objective
: Our objective is to analyze the occurrence, clinical course and risk factors for glioma patients with leptomeningeal metastasis (LM) according to different metastasis patterns and clinical variables.
Methods
: We retrospectively reviewed data from 376 World Health Organization (WHO) grade II–IV adult glioma patients who were treated in the National Cancer Center from 2001 to 2020. Patients who underwent surgery at other institutions, those without initial images or those with pathologically unconfirmed cases were excluded. LM was diagnosed based on magnetic resonance imaging (MRI) findings or cerebrospinal fluid (CSF) cytology. The metastasis pattern was categorized as nodular or linear according to the enhancement pattern. Tumor proximity to the CSF space was classified as involved or separated, whereas location of the tumor was dichotomized as midline, for tumors residing in the thalamus, basal ganglia and brainstem, or lateral, for tumors residing in the cerebral and cerebellar hemispheres.
Results
: A total of 138 patients were enrolled in the study. A total of 44 patients (38%) were diagnosed with LM during a median follow-up of 9 months (range, 0–60). Among the clinical variables, tumor proximity to CSF space, the location of the tumor and the WHO grade were significant factors for LM development in univariate analysis. In multivariate analysis, the midline location of the tumor and WHO grade IV gliomas were the most significant factor for LM development. The hazard ratio was 2.624 for midline located gliomas (95% confidence interval [CI], 1.384–4.974; p=0.003) and 3.008 for WHO grade IV gliomas (95% CI, 1.379–6.561; p=0.006).
Conclusion
: Midline location and histological grading are an important factor for LM in glioma patients. The proximity to the CSF circulation pathway is also an important factor for WHO grade IV glioma LM. Patients carrying high risks should be followed up more thoroughly.

Keyword

Glioma; Leptomeningeal metastasis; Risk factors; Magnetic resonance imaging

Figure

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  Fig. 1. Flow diagram of patient selection. WHO : World Health Organization, MRI : magnetic resonance imaging, CSF : cerebrospinal fluid.

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  Fig. 2. The tumor proximity to the cerebrospinal fluid pathway. Axial (A) and coronal (B) images of “involved” proximity. “Involved” proximity was defined as when the tumor was in contact with the pial surface or ventricular wall without intervening brain parenchyma and/or accompanied by pial or ependymal enhancement over the tumor. Axial (C) and coronal (D) images of “separated” proximity. “Separated” proximity was defined as when the tumor was not in contact with the pial surface or ventricular wall and was separated by brain parenchyma.

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  Fig. 3. Different leptomeningeal metastasis patterns of gliomas on magnetic resonance imaging. “Nodular” leptomeningeal metastasis shows dot-shaped enhancement (A), whereas (B) “linear” leptomeningeal metastasis shows disseminated or diffuse enhancement along the leptomeningeal surface. Lesions are circled in yellow.

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  Fig. 4. Kaplan-Meier survival curve of all patients for the development of leptomeningeal metastasis. Development of leptomeningeal metastasis was significantly different according to the location (A) and tumor involvement of cerebrospinal fluid space (B).

Reference

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