Page 172 - Read Online

analysis (group by treatment as IT DXM and MTX enter the Cox’s model (KPS, P = 0.935; age, P = 0.270;
group/palliative care group; log-rank test) was gender, P = 0.726; primary tumor, P = 0.220; cranial
conducted [Table 2 and Figure 2]. The OS of IT DXM nerve damage, P = 0.564; seizure, P = 0.605; confusion,
and MTX group was significantly longer than that P = 0.485; hemoglobin level, P = 0.434; albumin level,
of the palliative care group (P = 0.01). The median P = 0.658; globulin level, P = 0.781).
survival of palliative care group is 7.53 weeks (5.5-9.57;
n = 15), and have the IT DXM and MTX group, Bias analysis
28.63 weeks (12.50-44.75; n = 8), of the total patients, There are some innate biases in retrospective studies.
14.87 weeks (7.93-21.81 weeks; n = 23). Recall bias and confounding bias were the most
important biases in our study. Recall bias is innate and
We collected the patients’ characteristics, symptoms, uncontrollable, so the conclusion about IT treatment
treatment method, and some laboratory examinations may be not well-grounded. For the latter bias, we
at the initial diagnosis of NM, including IT DXM and analyzed some confounding factors between IT DXM
MTX, KPS, age, gender, primary tumor, cranial nerves and MTX group and palliative care group. We used
damage, spinal nerves damage, seizure, confusion, and KPS as a quantitative index of the subjects’ condition.
level of hemoglobin, albumin, and globulin. We analyzed There were no differences in KPS (2 independent
the possible survival ratio of these factors using Cox’s samples t-test, P = 0.733) and gender (Fisher exact
proportional hazards regression model and the method t-test, P = 0.367) between the groups, so we can
of forward LR, by entering the factor when P < 0.05 and exclude the imbalanced distribution of the KPS and
removing it when P > 0.06. IT DXM and MTX prolonged gender and its effects on the different OS between the
the OS of NM (regression coefficient = -2.923), odds groups. Age of IT DXM and MTX group is higher than
ratio (OR) = 0.054 (0.09-0.323). Spinal nerves damage that of palliative group [Mann-Whitney U, P = 0.043;
decreased the OS (regression coefficient = 1.595), 60.5 (56.5, 64.5) vs. 55 (44, 66)]. Aged patients present
OR = 4.928 (1.382-17.579). Other factors did not negative prognostic factors, [23,24] but IT DXM and
MTX group had elder age and longer survival. This is
Table 1: The patients’ characteristics possibly because of the different treatment methods.
n (ratio or Given a small number of cases, we just compare the
range) proportion of lung cancer and breast cancer, finding
IT DXM and MTX group/ 8/15 no difference between the groups (Fisher exact t-test,
palliative care
Male/female 9/14 P = 0.685; P = 1.0, respectively), so we conclude
Age 55 (21‑67) that the primary cancer type was at an equilibrium
Presenting symptoms distribution. Moreover, there were some biases coming
High intracranial pressure 22
Unable to walk 3 from the researchers because this study didn’t involve
Visual loss 9 blind method in experimental design.
Hearing damage 4
Sphincter disturbances 4
Seizure 6 DISCUSSION
Confusion 3
Cancer type (IT DXM and Neoplastic meningitis is a solid tumor at the advanced
MTX group/palliative care
group) stage during which patients usually has severe pain
Lung cancer 4/6 and must administrate painkillers frequently. The
Breast cancer 1/2 diagnosis of NM often leads to palliative treatment
Gastric cancer 0/1
Malignant melanoma 0/1 that is intended to preclude the additional discomfort
Unknown 3/5 with aggressive treatment. Meningitis, seizure, vomit
Concurrent treatment or sort of adverse effects were reported in the past
IT DXM and MTX 8
Systemic chemo 1 studies. In our study, the patients in IT DXM and
WBRT 2 MTX group show no obvious side effects. This may
VP shunt 1 be caused by a small number of cases, but we think
IT DXM and MTX: intrathecal dexamethasone and methotrexate;
VP: ventriculoperitoneal; WBRT: whole brain radiotherapy that side effects could be decreased if the drugs were

Table 2: Overall survival of different treatments
Treatment n Median OS 95% CI P (log‑rank)
weeks
Palliative care group 15 7.53 5.50‑9.57 0.01
IT DXM and MTX 8 28.63 12.50‑44.75
Total 23 14.87 7.93‑21.81
IT DXM and MTX: intrathecal dexamethasone and methotrexate; CI: confidence interval; OS: overall survival

164 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 165