中国癌症杂志 ›› 2021, Vol. 31 ›› Issue (2): 126-135.doi: 10.19401/j.cnki.1007-3639.2021.02.007

• 论著 • 上一篇    下一篇

胃癌脑膜转移的临床病理学特征及预后分析

丁平安 1 ,张志栋 1 ,杨沛刚 1 ,林叶成 1 ,田 园 1 ,徐校胜 2 ,吴 娟 3 ,刘 颖 3 ,郭洪海 1 ,刘 洋 1 ,王 冬 1 ,檀碧波 1 ,李 勇 1 ,赵 群 1
  

  1. 1 河北医科大学第四医院外三科,河北 石家庄 050011 ;
    2 河北医科大学第四医院 CT 影像科,河北 石家庄 050011 ;
    3 河北医科大学第四医院病理科,河北 石家庄 050011
  • 出版日期:2021-02-28 发布日期:2021-03-02
  • 通信作者: 赵 群 E-mail: zhaoqun@hebmu.edu.cn
  • 基金资助:
    河北卫健委县级公立医院适宜卫生技术推广入库项目(2019024);政府资助临床医学优秀人才培养项目(2019012);河北省高等学校科学技术研究项目(ZD2019139)。

Clinicopathological characteristics and prognostic analysis of leptomeningeal metastasis from gastric cancer

DING Ping’an 1 , ZHANG Zhidong 1 , YANG Peigang 1 , LIN Yecheng 1 , TIAN Yuan 1 , XU Xiaosheng 2 , WU Juan 3 , LIU Ying 3 , GUO Honghai 1 , LIU Yang 1 , WANG Dong 1 , TAN Bibo 1 , LI Yong 1 , ZHAO Qun 1 #br#   

  1. 1. Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China; 2 Department of CT Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China; 3 Department of Pathology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
  • Published:2021-02-28 Online:2021-03-02
  • Contact: ZHAO Qun E-mail: zhaoqun@hebmu.edu.cn

摘要: 背景与目的:胃癌脑膜转移是胃癌转移到中枢神经系统的一种特殊形式,具有与其他晚期胃癌明显不同的生物学特点。探讨胃癌合并脑膜转移患者(gastric cancer with leptomeningeal metastasis,GCLM)的临床病理学特征和预后生存分析。方法:检索河北医科大学第四医院外三科2010年—2019年录入的胃癌数据库,筛选出经影像学检查或脑脊液穿刺细胞学检查证实为GCLM患者,分析其临床病理学特征、生存预后及影响预后的相关因素。结果:共检索出50例GCLM患者,占同期收治胃癌患者总数0.82%。其中男性30例(60.00%),女性20例(40.00%);中位年龄54岁(95% CI:41~66岁),其中≤50岁22例(44.00%),>50岁28例(56.00%);病理学类型:低分化腺癌29例(58.00%),印戒细胞癌及黏液腺癌18例(36.00%),混合型神经内分泌癌3例(6.00%)。50例GCLM患者均为异时性脑膜转移,从胃癌诊断至发生GCLM中位时间为13.8个月(95% CI:5.5~20.9个月),其中出现脑功能损害及脑膜刺激症状者23例(46.00%),出现脑神经功能受累表现者18例(36.00%),出现脊神经功能受损症状者19例(38.00%)。全组患者行腰椎穿刺,脑脊液检查平均次数为3次,其中行1次穿刺脑脊液细胞学阳性为46.00%(23/50),第2次腰椎穿刺后阳性率为76.19%(32/42),第3次阳性率为77.14%(27/35)。全组患者发生脑膜转移后中位生存时间为3.8个月(95% CI:1.30~8.60个月),Cox多因素分析结果显示,血清中肿瘤标志物糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)的表达阳性(HR=2.458,95% CI:1.189~5.080,P=0.015)、同时合并其他远处脏器转移(HR=3.593,95% CI:1.365~9.456,P=0.010)是影响GCLM患者预后的独立危险因素,而发生脑膜转移后进行系统化疗则是保护性因素(HR=0.170,95% CI:0.049~0.591,P=0.005)。结论:对临床分期较晚的胃癌患者出现头痛、恶心呕吐,同时伴颅内压增高及脑膜刺激征,应高度警惕GCLM的可能;应用全身治疗联合局部治疗有助于延长GCLM患者的生存时间,改善预后。

关键词: 胃癌, 脑膜转移, 临床病理学特征, 预后

Abstract: Background and purpose: Leptomeningeal metastasis in gastric cancer is a special form of gastric cancer metastasis to the central nervous system, which has distinct biological characteristics different from other advanced gastric cancers. This study aimed to explore the clinicopathological characteristics and prognostic survival analysis of patients with gastric cancer and leptomeningeal metastasis (GCLM). Methods: The gastric cancer database established by the Third Department of Surgery of the Fourth Hospital of Hebei Medical University from 2010 to 2019 was searched, patients with GCLM confirmed by imaging examination or cerebrospinal fluid cytology were selected, and their clinicopathological characteristics, survival prognosis and related factors of prognosis were analyzed. Results: A total of 50 GCLM patients were retrieved, accounting for 0.82% of the total gastric cancer patients. Among them, 30 cases were male (60.00%), and 20 cases were female (40.00%); the median age was 54 years (95% CI: 41-66 years), of which 22 cases (44.00%) were less than 50 years, and 28 cases were more than 50 years (56.00%); pathological types: 29 cases of poorly differentiated adenocarcinoma (58.00%), 18 cases of signet ring cell carcinoma and mucinous adenocarcinoma (36.00%), and 3 cases of mixed neuroendocrine carcinoma (6.00%). The 50 cases of GCLM patients were metachronous meningeal metastases. The median time from the diagnosis of gastric cancer to the onset of GCLM was 13.8 months (95% CI: 5.5-20.9 months), of which 23 cases had brain damage and meningeal irritation (46.00%), 18 cases had symptoms of cranial nerve function involvement (36.00%), and 19 cases had symptoms of spinal nerve function impairment (38.00%). The average number of lumbar puncture cerebrospinal fluid examinations in the whole group of patients was 3 times, of which the positive rate of cerebrospinal fluid cytology was 46.00% (23/50) after one puncture, and the positive rate after the second lumbar puncture was 76.19% (32/42). The 3rd positive rate was 77.14% (27/35). The median survival time after meningeal metastasis of the whole group was 3.8 months (95% CI: 1.30-8.60). The results of Cox multivariate analysis showed that the positive expression of the tumor marker CA19-9 in serum (HR=2.458, 95% CI: 1.189-5.080, P=0.015) and other distant organ metastases (HR=3.593, 95% CI, 1.365-9.456, P=0.010) were independent risk factors affecting the prognosis of GCLM patients, while chemotherapy after meningeal metastasis was a protective factor (HR=0.170, 95% CI: 0.049-0.591, P=0.005). Conclusion: For patients with late clinical stage of gastric cancer who have headache, nausea and vomiting, accompanied by increased intracranial pressure and meningeal irritation, one should be highly vigilant about the possibility of GCLM. Application of systemic therapy combined with local therapy can help prolong the survival time of patients with GCLM and improve the prognosis.

Key words: Gastric cancer, Leptomeningeal metastasis, Clinical features, Prognosis