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Leptomeningeal metastases in glioma revisited: incidence and molecular predictors based on postcontrast fluid-attenuated inversion recovery imaging

Authors
 Yae Won Park  ;  Kyunghwa Han  ;  Ji Eun Park  ;  Sung Soo Ahn  ;  Eui Hyun Kim  ;  Jinna Kim  ;  Seok-Gu Kang  ;  Jong Hee Chang  ;  Se Hoon Kim  ;  Seung-Koo Lee 
Citation
 JOURNAL OF NEUROSURGERY, Vol.139(1) : 38-48, 2023-07 
Journal Title
JOURNAL OF NEUROSURGERY
ISSN
 0022-3085 
Issue Date
2023-07
MeSH
Adult ; Biomarkers ; Brain Neoplasms* / diagnostic imaging ; Brain Neoplasms* / genetics ; Glioma* / diagnostic imaging ; Glioma* / genetics ; Humans ; Incidence ; Isocitrate Dehydrogenase / genetics ; Magnetic Resonance Imaging / methods ; Mutation
Keywords
glioma ; leptomeningeal metastases ; magnetic resonance imaging ; molecular diagnostics ; oncology ; tumor
Abstract
OBJECTIVE: Leptomeningeal metastases (LMs) in glioma have been underestimated given their low incidence and the lack of reliable imaging. Authors of this study aimed to investigate the real-world incidence of LMs using cerebrospinal fluid (CSF)-sensitive imaging, namely postcontrast fluid-attenuated inversion recovery (FLAIR) imaging, and to analyze molecular predictors for LMs in the molecular era. METHODS: A total of 1405 adult glioma (World Health Organization [WHO] grade 2-4) patients underwent postcontrast FLAIR imaging at initial diagnosis and during treatment monitoring between 2001 and 2021. Collected molecular data included isocitrate dehydrogenase (IDH) mutation, 1p/19q codeletion, H3 K27 alteration, and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status. LM diagnosis was performed with MRI including postcontrast FLAIR sequences. Logistic regression analysis for LM development was performed with molecular, clinical, and imaging data. Overall survival (OS) was compared between patients with and those without LM. RESULTS: LM was identified in 228 patients (16.2%), 110 (7.8%) at the initial diagnosis and 118 (8.4%) at recurrence. Among the molecular diagnostics, IDH-wildtype (OR 3.14, p = 0.001) and MGMT promoter unmethylation (OR 1.43, p = 0.034) were independent predictors of LM. WHO grade 4 (OR 10.52, p < 0.001) and nonlobar location (OR 1.56, p = 0.048) were associated with LM at initial diagnosis, whereas IDH-wildtype (OR 5.04, p < 0.001) and H3 K27 alteration (OR 3.39, p = 0.003) were associated with LM at recurrence. Patients with LM had a worse median OS than those without LM (16.7 vs 32.0 months, p < 0.001, log-rank test), which was confirmed as an independent factor on multivariable Cox analysis (p = 0.004). CONCLUSIONS: CSF-sensitive imaging aids the diagnosis of LM, demonstrating a high incidence of LM in adult gliomas. Furthermore, molecular markers are associated with LM development in glioma, and patients with aggressive molecular markers warrant imaging surveillance for LM.
Full Text
https://thejns.org/view/journals/j-neurosurg/139/1/article-p38.xml
DOI
10.3171/2022.9.JNS221659
Appears in Collections:
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
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)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/198363
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