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Revisiting prognostic factors in glioma with leptomeningeal metastases: a comprehensive analysis of clinical and molecular factors and treatment modalities

 Yae Won Park  ;  Kyunghwa Han  ;  Sooyon Kim  ;  Hyuk Kwon  ;  Sung Soo Ahn  ;  Ju Hyung Moon  ;  Eui Hyun Kim  ;  Jinna Kim  ;  Seok-Gu Kang  ;  Jong Hee Chang  ;  Se Hoon Kim  ;  Seung-Koo Lee 
 JOURNAL OF NEURO-ONCOLOGY, Vol.162(1) : 59-68, 2023-03 
Journal Title
Issue Date
Adult ; Brain Neoplasms* / diagnosis ; Brain Neoplasms* / genetics ; Brain Neoplasms* / therapy ; Female ; Glioblastoma* ; Glioma* / genetics ; Glioma* / pathology ; Glioma* / therapy ; Humans ; Isocitrate Dehydrogenase / genetics ; Male ; Mutation ; Prognosis
Glioma ; Isocitrate dehydrogenase ; Leptomeningeal metastases ; Magnetic resonance imaging ; Survival
Purpose: To comprehensively investigate prognostic factors, including clinical and molecular factors and treatment modalities, in adult glioma patients with leptomeningeal metastases (LM).

Methods: Total 226 patients with LM (from 2001 to 2021 among 1495 grade 2 to 4 glioma patients, 88.5% of LM patients being IDH-wildtype) with complete information on IDH mutation, 1p/19q codeletion, and MGMT promoter methylation status were enrolled. Predictors of overall survival (OS) of entire patients were determined by time-dependent Cox analysis, including clinical, molecular, and treatment data. Subgroup analyses were performed for patients with LM at initial diagnosis and LM diagnosed at recurrence (herein, initial and recurrent LM). Identical analyses were performed in IDH-wildtype glioblastoma patients.

Results: Median OS was 17.0 (IQR 9.7-67.1) months, with shorter median OS in initial LM than recurrent LM patients (12.2 vs 20.6 months, P < 0.004). In entire patients, chemotherapy and antiangiogenic therapy were predictors of longer OS, while male sex and initial LM were predictors of shorter OS. In initial LM, higher KPS, chemotherapy, and antiangiogenic therapy were predictors of longer OS, while male sex was a predictor of shorter OS. In recurrent LM, chemotherapy and longer interval between initial glioma and LM diagnoses were predictors of longer OS, while male sex was a predictor of shorter OS. A similar trend was observed in IDH-wildtype glioblastoma.

Conclusion: Active chemotherapy and antiangiogenic therapy demonstrated survival benefit in glioma patients with LM. There is consistent female survival advantage, whereas longer interval between initial glioma diagnosis and LM development suggests longer OS in recurrent LM.
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Appears in Collections:
1. College of Medicine (의과대학) > Research Institute (부설연구소) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Gu(강석구) ORCID logo https://orcid.org/0000-0001-5676-2037
Kim, Se Hoon(김세훈) ORCID logo https://orcid.org/0000-0001-7516-7372
Kim, Eui Hyun(김의현) ORCID logo https://orcid.org/0000-0002-2523-7122
Kim, Jinna(김진아) ORCID logo https://orcid.org/0000-0002-9978-4356
Moon, Ju Hyung(문주형)
Park, Yae Won(박예원) ORCID logo https://orcid.org/0000-0001-8907-5401
Ahn, Sung Soo(안성수) ORCID logo https://orcid.org/0000-0002-0503-5558
Lee, Seung Koo(이승구) ORCID logo https://orcid.org/0000-0001-5646-4072
Chang, Jong Hee(장종희) ORCID logo https://orcid.org/0000-0003-1509-9800
Han, Kyung Hwa(한경화)
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