Clinical characteristics of glioblastoma with metastatic spinal dissemination

Abstract

Background: Metastatic spinal dissemination (MSD) is a rare phenomenon in glioblastoma (GBM). The study aimed to analyze the clinical characteristics of GBM patients with MSD. Methods: Fifteen GBM patients with MSD, who were treated and followed up with at the Department of Oncology, Beijing Shijitan Hospital, Capital Medical University from September 2012 to February 2021, were selected for this study. Clinical data, such as demographic characteristics, clinical manifestation, imaging, cerebrospinal fluid (CSF), treatment and prognosis data, were retrospectively analyzed. The time to MSD and overall survival (OS) were estimated using Kaplan-Meier plotting. A univariate analysis was performed using a logarithmic-rank test, and a multivariate analysis was performed using Cox proportional hazards models. Results: Of the 15 GBM patients with MSD (9 males and 6 females), the primary lesions were located supratentorial region in 12 cases, and subtentorial region in 3 cases. After surgery, the ventricles were open and closed in 7 and 8 cases, respectively. There were 10 cases, 2 cases, 2 cases, and 1 case of MSD in the full spinal cord (FSC), FSC with spinal cord intramedullary infiltration, cervical spinal cord intramedullary infiltration, and cervical/thoracic MSD, respectively. Whole spinal cord magnetic resonance imaging (MRI) showed dotted-line, nodules, and mixed patterns in 3, 2, and 10 cases, respectively. The average CSF protein level during MSD was 2.49 (range, 0.42–6.68) g/L, and the average CSF d-dimer level was 23,718 (range, 4,056–69,000) ng/L. By the end of the follow-up period, all the patients had died. The median OS of all patients, the median time from surgery to diagnosis of MSD, and the median time after MSD to death was 15.0 (range, 8–52), 10.0 (range, 1–49), and 4.0 (range, 1–14) months, respectively. Conclusions: MSD is a rare, metastasized type of GBM. The OS after MSD in GBM patients is very short. Whole spinal cord-enhanced MRI may be the best way to determine the range of MSD.