Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Leptomeningeal Metastasis in Gliomas : Clinical Characteristics and Risk Factors

  • Jeyul Yang (Department of Neurosurgery, Myongji Hospital) ;
  • Ji-Woong Kwon (Neuro-oncology Clinic, National Cancer Center) ;
  • Sang Hoon Shin (Neuro-oncology Clinic, National Cancer Center) ;
  • Heon Yoo (Neuro-oncology Clinic, National Cancer Center) ;
  • Kyu-Chang Wang (Neuro-oncology Clinic, National Cancer Center) ;
  • Sang Heyon Lee (Department of Radiology, National Cancer Center) ;
  • Ho-Shin Gwak (Department of Cancer Control, Graduate School of Cancer Science and Policy)
  • Received : 2022.07.13
  • Accepted : 2022.12.06
  • Published : 2023.07.01
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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.

Keywords

Acknowledgement

This work was supported by a grant (2210650-2) from the National Cancer Center, Korea. The sponsor had no role in the design or conduct of this research.

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