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Prognostic impact of clinical and radiological factors on leptomeningeal metastasis from solid cancers

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Abstract

Purpose

The number of leptomeningeal metastasis (LM) patients has increased in recent years, as the cancer survival rates increased. An optimal prediction of prognosis is essential for selecting an appropriate treatment. The European Association of Neuro-Oncology-European Society for Medical Oncology (EANO-ESMO) guidelines for LM proposed a classification based on the cerebrospinal fluid cytological findings and contrast-enhanced magnetic resonance imaging (MRI) pattern. However, few studies have validated the utility of this classification. This study aimed to investigate the prognostic factors of LM, including the radiological and cytological types.

Methods

We retrospectively analyzed the data of 240 adult patients with suspected LM who had undergone lumbar puncture between April 2014 and September 2021.

Results

The most common primary cancer types were non-small-cell lung cancer (NSCLC) (143 (60%)) and breast cancer (27 (11%)). Positive cytology results and the presence of leptomeningeal lesions on contrast-enhanced MRI correlated with decreased survival in all patients. Nodular lesions detected on contrast-enhanced magnetic resonance were a poor prognostic factor in cytology-negative patients, while contrast-enhanced patterns had no prognostic significance in cytology-positive patients. Systemic therapy using cytotoxic agents and molecular-targeted therapy after LM diagnosis correlated with prolonged survival, regardless of the cytology results. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor treatment and systemic chemotherapy after LM improved the survival of EGFR-mutated and wild-type NSCLC patients with positive cytology results.

Conclusions

This study validated the efficacy of prognostication according to the EANO-ESMO guidelines for LM. Systemic therapy after LM diagnosis improves the survival of NSCLC patients.

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Data availability

The data generated and analyzed during the current study are not publicly available for legal/ethical reasons but are available from the corresponding author upon reasonable request.

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Acknowledgements

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Funding

The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-Ku, Osaka, 541-8567, Japan

    Kanji Nakagawa, Koji Takano & Hideyuki Arita

  2. Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Kanji Nakagawa

  3. Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan

    Kazumi Nishino

  4. Department of Dermatologic Oncology, Osaka International Cancer Institute, Osaka, Japan

    Shuichi Ohe

  5. Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan

    Takahiro Nakayama

Authors
  1. Kanji Nakagawa
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  4. Shuichi Ohe
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  5. Takahiro Nakayama
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Contributions

KNa, KT, and HA acquired data.

KNa and HA analyzed the data.

KNa, KNi, SO, TN and HA wrote the manuscript.

HA conceptualized the research.

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hideyuki Arita.

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Competing interests

The authors declare no competing interests.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board of the Osaka International Cancer Institute (reference no. 21122).

Consent to participate

The local institutional review board waivered written informed consent from patients for using clinical data for the present research.

Conflict of interests

The authors declare that they have no conflicts of interest in association with this study.

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Nakagawa, K., Takano, K., Nishino, K. et al. Prognostic impact of clinical and radiological factors on leptomeningeal metastasis from solid cancers. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04616-3

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