63例脑膜转移瘤临床分析

Clinical analysis of carcinomatous meningitis in 63 cases

目的 探讨脑膜转移瘤（CM）的临床表现和治疗方法及其与预后关系.方法 回顾本院1998-2008年确诊的63例CM患者病历资料,分析其临床表现及不同治疗方式与预后关系.63例CM患者中原发灶以肺癌（65%）及乳腺癌（13%）多见.所有患者均经增强MRI检查,29例患者同时行腰穿检查.51例患者接受了全脑放疗、全身化疗和（或）鞘内化疗,其余12例患者单纯对症支持治疗.采用Kaplan-Meier法进行生存分析.结果 所有患者在随访期内全部死亡,随访率为95%,其中随访满1、2年者分别为59、56例.全组患者中位总生存期为2.2个月（0.1～24.4个月）.确诊CM前临床分期（x2=6.68,P=0.036）及原发灶控制情况（x2=7.04,P=0.008）与生存明显相关.放疗剂量≥30 Gy者与未放疗者中位生存期分别为3.0个月（1.0～24.4个月）和1.8个月（0.1～14.2个月）（x2=5.54,P=0.019）;放疗±化疗组、单纯化疗组及单纯对症治疗组中位生存期分别为3.0个月（0.5～24.4个月）、2.2个月（0.3～14.2个月）和1.2个月（0.1～4.5个月）（x2=9.32,P=0.009）.结论 CM预后较差,CM前临床分期及原发灶控制情况与生存明显相关,足量放疗有望延长患者生存期,但尚需大样本临床研究证实.

Objective To analyze the clinical characteristics and the prognostic factors of carcinomatous meningitis（CM）. Methods 63 patients with CM treated in Tianjin Medical University Cancer Institute and Hospital from 1998 to 2008 were reviewed retrospectively. The correlations between clinical characteristics, treatment modalities and the prognosis of CM were analyzed. The common primary site was lung cancer（65%）and breast cancer（13%）. All the patients were underwent MRI scan and 29 of the patients received lumbar puncture. Fifty-one patients received whole brain radiotherapy, systemic and/or intrathecal chemotherapy. The other 12 patients only received supportive care. Kaplan-Meier method and Log-rank test were used for survival analysis. Results All patients died by the end of follow-up. The follow-up rate was 95%. The number of patients who undergone 1-,2 years follow-up were 59 and 56. The median survival time was 2. 2 months（range ：0. 1 -24. 4 months）for the entire group. The clinical stage and the control status of the primary disease were strongly correlated with survival（x2 = 6. 68, P = 0. 036）and（x2 = 7.04, P = 0. 008）. The median survival time was 3.0 months（range： 1.0 - 24. 4 months）in patients who received ≥30 Gy whole brain irradiation, while only 1.8 months（range：0. 1-14. 2 months）in those who did not receive radiotherapy（x2 =5.54,P =0. 019）. The median survival time of radiotherapy ± chemotherapy group, chemotherapy only group and supportive treatment only group were 3.0 months （range ：0. 5 - 24. 4 months）, 2. 2 months（range ：0. 3 - 14. 2 months）and 1. 2 months（range ：0. 1 - 4.5 months）, respectively（x2 = 9. 32, P = 0. 009）. Conclusions The prognosis of CM is very poor. The clinical stage before the diagnosis of CM and the control status of primary disease and were significantly correlated with survival. Sufficient whole brain irradiation dose may prolong survival and worth further study in a large sample study.