肺癌硬膜下脊髓外转移患者临床特征分析

Clinical Features of Intradural Extramedullary Spinal Cord Metastases in Primary Lung Cancer

背景与目的肺癌硬膜下脊髓外转移罕见,可导致严重的神经损害,本研究旨在阐明其临床特征。方法 2013年5月-2016年5月,北京协和医院8例确诊硬膜下脊髓外转移肺癌患者纳入该研究,系统回顾分析临床资料。结果 7例非小细胞肺癌及1例小细胞肺癌合并硬膜下脊髓外转移。马尾综合征是最常见的临床表现。行腰椎穿刺的5例(100%)患者脑脊液找到肿瘤细胞。脊髓增强核磁(magnetic resonance imaging,MRI)发现,3例软脊膜弥漫线样增强,4例硬膜下脊髓外多发结节,1例具有上述两种表现。4例接受靶向治疗和/或放疗患者神经系统症状改善或稳定。中位生存时间是5.8个月。结论硬膜下脊髓外转移需依靠神经系统症状及增强MRI影像学检查诊断。靶向治疗和/或放疗可能有效。

Background and objective Intradural extramedullary spinal cord metastases in lung cancer is rare, and it leads to severe neurological damage. The aim of this study is to identify the clinical features of intradural extramedullary spinal cord metastases in primary lung cancer patients. Methods The 8 cases of lung cancer with intradural extramedullary metastases, who were hospitalized in Peking Union Medical College Hospital（PUMCH） during May 2013 to May 2016, were enrolled in the retrospective study. Medical charts of the 8 patients were reviewed systematically. Results Intradural extramedullary spinal cord metastases was diagnosed in 7 cases with non-small cell lung cancer（NSCLC） and 1 case with small cell lung cancer（SCLC）. Cauda equina syndrome was the most common clinical manifestation. Malignant cells in cerebrospinal fluid were positive in all the 5 cases（100%） who underwent lumbar puncture. Contrast-enhanced magnetic resonance imaging（MRI） of spine manifested as diffuse abnormal enhancement of pial lining of spinal cordin 3 cases, intradural extramedullary nodules in 4 cases, and both of them in 1 case. Neurological symptoms were improved or stable in 4 cases who underwent targeted therapy and/or radiotherapy. The median overall survival was 5.8 months. Conclusion Intradural extramedullary spinal cord metastases can be diagnosed with caution according to its neurological symptoms and contrast-enhanced MRI presentation.Targeted therapy and/or radiotherapy may be effective for symptoms control.