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Leptomeningeal metastases at recurrence in IDH-wildtype glioblastomas: incidence, risk factors, and prognosis based on postcontrast FLAIR imaging

Authors
 Yae Won Park  ;  Geon Jang  ;  Si Been Kim  ;  Kyunghwa Han  ;  Na-Young Shin  ;  Sung Soo Ahn  ;  Jong Hee Chang  ;  Se Hoon Kim  ;  Rajan Jain  ;  Seung-Koo Lee 
Citation
 EUROPEAN RADIOLOGY, Vol.35(8) : 5099-5109, 2025-08 
Journal Title
EUROPEAN RADIOLOGY
ISSN
 0938-7994 
Issue Date
2025-08
MeSH
1
Keywords
Adult ; Aged ; Brain Neoplasms* / diagnostic imaging ; Brain Neoplasms* / genetics ; Brain Neoplasms* / pathology ; Contrast Media ; Female ; Glioblastoma* / diagnostic imaging ; Glioblastoma* / genetics ; Glioblastoma* / pathology ; Humans ; Incidence ; Isocitrate Dehydrogenase / genetics ; Magnetic Resonance Imaging* / methods ; Male ; Meningeal Neoplasms* / diagnostic imaging ; Meningeal Neoplasms* / epidemiology ; Meningeal Neoplasms* / genetics ; Meningeal Neoplasms* / secondary ; Middle Aged ; Neoplasm Recurrence, Local* / diagnostic imaging ; Prognosis ; Retrospective Studies ; Risk Factors
Abstract
Glioblastoma ; Leptomeningeal metastases ; Magnetic resonance imaging ; Prognosis ; Risk factors
Article Number
 10.1007/s00330-025-11447-x 
DOI
Objectives: To comprehensively investigate the incidence, risk factors, and prognosis of leptomeningeal metastases (LM) diagnosed at recurrence in IDH-wildtype glioblastoma patients. Materials and methods: A total of 734 IDH-wildtype glioblastoma patients were enrolled between 2005 and 2022. LM at recurrence was diagnosed with MRI including postcontrast FLAIR. Logistic analysis for development of LM at recurrence was performed with clinical, molecular, imaging (including tumor volume and distance to subventricular zone via automatic segmentation), and surgical data including extent of resection and ventricular entry. The overall survival (OS) was compared between patients with and without LM at recurrence. Results: The incidence of LM at recurrence based on postcontrast FLAIR was 10.8% (79 patients). On multivariable analysis, younger age at diagnosis (odds ratio (OR) = 0.98, p = 0.011) and ventricular entry (OR = 3.15, p < 0.001) were independent predictors of LM at recurrence. However, patients with LM at recurrence showed no significant difference in OS from patients without LM (log-rank test; p = 0.461), with median OS of 18.0 (95% confidence interval (CI) 16.2-19.8) and 18.5 (95% CI 16.4-20.7) months in patients with and without LM at recurrence, respectively. Conclusion: The incidence of LM at recurrence is relatively high in IDH-wildtype glioblastoma patients. Younger age and ventricular entry during surgery warrant imaging surveillance for LM at recurrence. As LM at recurrence showed no significant OS compromise and larger extent of resection (EOR) is associated with survival benefits, ventricular entry during maximal safe resection may be acceptable. Key points: Question The incidence, risk factors, and prognosis of leptomeningeal metastases (LM) diagnosed at recurrence in IDH-wildtype glioblastoma patients are currently unknown. Findings LM at recurrence occurred in 10.8% of cases, with younger age and ventricular entry as risk factors, but no significant difference in survival outcomes between groups. Clinical relevance The incidence, risk factors, and prognosis of LM at recurrence were investigated in IDH-wildtype glioblastoma patients with postcontrast FLAIR. Younger age and ventricular entry warrant surveillance of LM at recurrence, while the overall survival is not as discouraging as expected.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Se Hoon(김세훈) ORCID logo https://orcid.org/0000-0001-7516-7372
Park, Yae Won(박예원) ORCID logo https://orcid.org/0000-0001-8907-5401
Shin, Na Young(신나영)
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/22282913/207480
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