| Objective: Meningeal carcinomatosis refers to a serious and rare central nervous system(CNS)complication in the late stage of cancer.In China,MC is most common in lung cancer,rare in gastric cancer.In this paper,we analyzed the relevant clinical data of 18 patients with meningeal metastasis of gastric cancer admitted to our hospital to improve the understanding of meningeal carcinomatosis of gastric cancer origin.And this paper analyzes the survival of various prognostic factors that may affect survival,which may have guiding significance for judging the prognosis of patients.Methods:1.Eighteen patients diagnosed with MC caused by gastric cancer in our hospital from April 2016 to December 2020 were collected.The clinical manifestations of all patients were analyzed,including the general clinical features,pathogenesis of MC,clinical symptoms,cerebrospinal fluid analysis,imaging examination,treatment methods and survival time of all patients.2.Origin software was used to draw the double Y axis diagram and line sequence diagram;SPSS 25 version statistical software was used for data analysis.The survival time was plotted by Kaplan-Meier method.The log-rank test was used to test the survival difference between the groups.P <0.05 was considered statistically significant.Results: The male-to-female ratio was 17:1,and the patients ranged in age from 30 to 72 years(median,62 years).The median interval from diagnosis of the primary malignancy to the diagnosis of MC was 6.0 months,ranging between 0 and 72 months.Headache(100%)and nausea/vomiting(50%)were the most common presenting symptoms of MC.Intracranial pressure was elevated in all 18 patients,with a mean intracranial pressure of402 mm H2 O,and leukocytes and proteins of CSF were elevated in 68.4% and47.4% of patients respectively.A gadolinium-enhanced magnetic resonance imaging was conducted in 12 patients.Leptomeningeal enhancement was noted in 6 cases(50%).Intrathecal chemotherapy was administered to 18 patients,13 patients were treated with intrathecal chemotherapy alone,and 5patients were treated with intrathecal chemotherapy combined with other treatments.Intrathecal chemotherapy was mainly performed using methotrexate10mg(11 patients,61.1%)or 15mg(7 patients,38.9%)in combination with dexamethasone 5mg,with survival of 16 and 7.9 weeks respectively,P=0.105,and the difference was not statistically significant.After induction treatment,four patients(22.2%)achieved cytological decrease by more than half comparing to baseline.Median overall survival duration from the diagnosis of MC was 10.9 week(95% confidence interval:2.446–15.354 weeks).Univariate analysis of prognostic factors that may affect survival including age,baseline KPS score,hemoglobin,MRI,intracranial pressure,the level of protein,the dose of intrathecal MTX,therapy regimen and the change of cerebrospinal fluid cytology showed that cerebrospinal fluid protein ≦0.45 g/L,combination therapy regimen,and improvement of cerebrospinal fluid cytology showed better survival(19,36 and 19 weeks,P=0.006,0.002 and 0.031,respectively),and the differences were statistically significant.Conclusion:1.MC caused by gastric cancer is relatively rare.The prognosis of MC is poor,and the survival time is usually a few weeks.Diagnosis is usually based on cerebrospinal fluid cytology and cranial contrast-enhanced MRI.The treatment of MC is relatively limited,and intrathecal chemotherapy is the most commonly used and basic treatment.For high-risk patients palliative treatment is usually,and for low-risk patients a more aggressive combination of treatment can be used.2.Normal cerebrospinal fluid protein levels,combined treatment regimens,and the improvement cerebrospinal fluid cytology may predict good survival. |
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