Mehta Vivek, Chapman Ann, McNeely P Daniel, Walling Simon, Howes William J
Division of Pediatric Neurosurgery, Stollery Children's Health Center, University of Alberta, Edmonton, Canada.
Neurosurgery. 2002 Aug;51(2):365-72; discussion 372-3.
Tumors of the central nervous system are now thought to be the most common form of childhood malignancies. Previous studies suggested that delays might exist between symptom onset and the diagnosis of pediatric brain tumors. In the Maritime Provinces of Canada (New Brunswick, Nova Scotia, and Prince Edward Island), there are only two pediatric neurosurgical centers; therefore, the Maritime Provinces are ideal for study of the epidemiological features of pediatric brain tumors. The aim of this study was to examine the incidence rates of pediatric brain tumors in eastern Canada, as well as factors important in their diagnosis.
We collected data on 104 cases during a 6-year period (1995-2000), both prospectively and retrospectively, for the Maritime pediatric neuro-oncology database. All < or =17-year-old patients in the Maritime Provinces with pediatric brain tumors were treated in one of two neurosurgical centers (St. John, New Brunswick, or Halifax, Nova Scotia).
The incidence rate for pediatric brain tumors was 4.28/100,000 child-yr. Tumors were more common among male patients and involved the infratentorial compartment in 65% of the total cases. The two most common types of tumors were astrocytomas (37%) and medulloblastomas (21%). The mean time to diagnosis was 7.3 months (95% confidence interval [CI], 4.99-9.67 mo), and only 41% of our cases were correctly diagnosed within three visits to various physicians. Tumors located in the brainstem required significantly longer times for diagnosis, compared with those located elsewhere (mean, 11.76 mo [95% CI, 3.13-20.39 mo] versus 6.57 mo [95% CI, 4.20-8.95 mo]; P = 0.014). Medulloblastomas as a group exhibited significantly shorter diagnostic times, compared with other pathological subtypes (mean, 3.78 mo [95% CI, 1.97-5.59 mo] versus 8.35 mo [95% CI, 5.40-11.3 mo]; P = 0.006).
The incidence rates for pediatric brain tumors in the Maritime Provinces are similar to those of other reported series. The correct diagnosis of pediatric brain tumors still generally requires a number of months and frequent visits to various physicians. The majority of pediatric brainstem tumors might no longer be of a diffuse malignant nature but might represent more-focal benign lesions.
中枢神经系统肿瘤目前被认为是儿童恶性肿瘤最常见的形式。先前的研究表明，儿童脑肿瘤从症状出现到诊断可能存在延迟。在加拿大的海洋省份（新不伦瑞克省、新斯科舍省和爱德华王子岛），仅有两个儿科神经外科中心；因此，海洋省份是研究儿童脑肿瘤流行病学特征的理想之地。本研究的目的是调查加拿大东部儿童脑肿瘤的发病率以及对其诊断具有重要意义的因素。
我们前瞻性和回顾性地收集了6年期间（1995 - 2000年）104例病例的数据，用于建立海洋儿科神经肿瘤数据库。海洋省份所有年龄≤17岁的儿童脑肿瘤患者均在两个神经外科中心之一（新不伦瑞克省的圣约翰或新斯科舍省的哈利法克斯）接受治疗。
儿童脑肿瘤的发病率为4.28/100,000儿童年。肿瘤在男性患者中更为常见，65%的病例累及幕下腔。两种最常见的肿瘤类型是星形细胞瘤（37%）和髓母细胞瘤（21%）。诊断的平均时间为7.3个月（95%置信区间[CI]，4.99 - 9.67个月），我们的病例中只有41%在看了不同医生三次以内得到正确诊断。与位于其他部位的肿瘤相比，位于脑干的肿瘤诊断所需时间明显更长（平均，11.76个月[95%CI，3.13 - 20.39个月]对6.57个月[95%CI，4.20 - 8.95个月]；P = 0.014）。作为一个整体，髓母细胞瘤的诊断时间明显短于其他病理亚型（平均，3.78个月[95%CI，1.97 - 5.59个月]对8.35个月[95%CI，5.40 - 11.3个月]；P = 0.006）。
海洋省份儿童脑肿瘤的发病率与其他报道系列相似。儿童脑肿瘤的正确诊断通常仍需要数月时间且需频繁看不同医生。大多数儿童脑干肿瘤可能不再具有弥漫性恶性性质，而可能代表更具局灶性的良性病变。
