Clinical predictors of leptomeningeal metastasis from lung adenocarcinoma based on retrospective analysis

Leptomeningeal metastasis (LM) is common in patients with lung adenocarcinoma, leading to high mortality rates. The predictors of systematic survival in patients with LM and lung adenocarcinoma remain poorly understood. The present study retrospectively analyzed 78 lung adenocarcinoma patients with or without LM treated at Ningbo Medical Center, Lihuili Hospital (Ningbo, China) between November 2016 and August 2024. Clinical characteristics and baseline hematological parameters obtained at LM diagnosis were evaluated for their associations with overall survival (OS). Median OS was 9.0 months (range: 0.2-48.9 months) in patients with LM. Univariate analysis identified age <60 years, Eastern Cooperative Oncology Group performance status (ECOG PS) 0-2, receipt of brain radiotherapy after a diagnosis of LM, no extracranial metastasis, epidermal growth factor receptor (EGFR) 19 mutation, receipt of third-generation EGFR tyrosine kinase inhibitor therapy before a diagnosis of LM, neutrophil-to-lymphocyte ratio <7.5755, platelet-to-lymphocyte ratio (PLR) <156.035 and a molecular graded prognostic assessment >1.5 to be significant predictors of superior OS. According to multivariate analysis, extracranial metastasis [hazard ratio (HR)=2.291; 95% CI, 1.074-4.888; P=0.032], PLR <156.035 (HR=0.233; 95% CI, 0.123-0.442; P<0.001) and ECOG PS 0-2 (HR=0.302; 95% CI, 0.152-0.599; P=0.001) remained predictive of OS. In conclusion, extracranial metastasis, PLR and ECOG PS were identified to be prospective independent clinical prognostic indicators of survival in patients with lung adenocarcinoma and LM. Overall, the present study highlighted the potential use of clinical characteristics and hematological variables before treatment to predict the outcomes of patients with lung adenocarcinoma complicated with LM.