Gastric leptomeningeal carcinomatosis: Multi-center retrospective analysis of 54 cases

Table 1 Patients’ characteristics (n = 54)

No. of patients	n (%)
Gender
Male/female	32 (59.3)/22 (40.7)
Age (yr)
Median (range)	48 (28-78)
≥ 60/< 60	15 (27.8)/39 (72.2)
Initial stage
I-II	2 (3.7)
III	2 (3.7)
IV	47 (87.0)
Not available	3 (5.6)
Operation
Curative	17 (31.5)
Palliative	15 (27.8)
Inoperable	18 (33.3)
Not available	4 (7.5)
Initial endoscopic finding (n = 47)
Site
Cardia	1 (1.9)
Fundus	1 (1.9)
Body	20 (37.0)
Antrum, pylorus	16 (29.7)
Diffuse whole stomach	9 (19.1)
Borrmann type (n = 45)
Early gastric cancer	2 (4.4)
I (polypoid)	1 (2.2)
II (ulcerative)	4 (8.9)
III (ucero-infiltrative)	23 (51.2)
IV (diffuse infiltrative)	15 (33.3)
Differentiation (n = 47)
Moderate	3 (6.4)
Poor	25 (53.2)
Poor with signet ring cell	19 (40.4)

Table 2 Patterns of leptomeningeal carcinomatosis (n = 54)

	n (%)
Time to LMC (mo)
Median (range)	6.3 (0-73.1)
LMC presentation
Curative/recurred/progression	7 (13.0)
Curative/recurred LMC	10 (18.5)
Metastatic/progression	32 (59.3)
Initially LMC	5 (9.3)

LMC: Leptomeningeal carcinomatosis.

Table 3 Symptoms of leptomeningeal carcinomatosis (n = 54)

	n (%)
Cerebral symptom
Headache	46 (85.1)
Nausea & vomiting	32 (59.2)
Dizziness	13 (24.0)
Mental change	12 (22.2)
Seizure	10 (18.5)
Gait difficulty	2 (3.7)
Dysarthria	2 (3.7)
Psychosis	1 (1.9)
Cranial symptom
Diplopia	3 (5.6)
Hearing loss	2 (3.7)
Facial palsy	1 (1.9)
Ptosis	1 (1.9)
Spinal symptom
Weakness	5 (11.1)
Paresthesia	2 (3.7)
Back pain	1 (1.9)

Table 4 CSF finding of leptomeningeal carcinomatosis

CSF	No. of > WNL1	mean ± SD
Pressure (mm CSF)	29/50 (58.0%)	222.1 ± 158.4
WBC (n/mm3)	41/52 (78.8%)	36.7 ± 59.0
Protein (mg/dL)	28/52 (53.8%)	129.5 ± 250.8

¹CSF pressure > 160 mm; CSF protein > 50 mg/dL; Cell count > 5/mm³. CSF: Cerebrospinal fluid; WNL: Within normal limit; WBC: White blood cell.

Table 5 Treatment with intrathecal chemotherapy (n = 36)

	n (%)
Regimen
MTx	22 (61.1)
MTx + steroid	4 (11.1)
MTx + Ara-C + steroid	10 (27.8)
Concurrent/sequential
+ alone	16 (44.4)
+ radiotherapy	13 (36.1)
+ chemotherapy	2 (5.6)
+ chemoradiotherapy	5 (13.9)
No. of cycles
Median (range)	7 (1-18)
Cytological response
(-) conversion	17 (47.2)

MTx: Methotrexate; Ara-C: Cytarabine.

Table 6 Survival duration and prognostic factors

Factors	Median OS (mo)	Univariate	Multivariate
Gender
Male	7.1	0.491	-
Female	6.7
Age (yr)
> 60	12.4	0.214	-
≤ 60	6.4
PS (LMC)
0, 1	11.7	0.975	-
≥ 2	6.4
Hb (LMC)
> 11	12.4	0.038	NS
≤ 11	5.7
MRI enhance
Negative	5.7	0.316	-
Positive	7.1
CSF pressure
> 120	6.4	0.163	NS
≤ 120	8.1
CSF protein
> 40	6.0	0.539	-
≤ 40	11.7
IT chemotherapy
No	3.6	0.010	NS
Yes	11.7
Radiotherapy
No	4.6	0.516	-
Yes	6.9
Cytologic response
No	5.1	0.002	0.030 (HR: 0.415, 95% CI: 0.188-0.918)
Yes	14.6

OS: Overall survival; PS (LMC): Performance status scale by Eastern Cooperative Oncology Group at leptomeningeal carcinomatosis; Hb (LMC): Hemoglobin at leptomeningeal carcinomatosis; MRI: Magnetic resonance imaging; CSF: Cerebrospinal fluid; IT: Intrathecal; HR: Hazard ration; CI: Confidence interval.