Reni Michele, Brandes Alba Ariela, Vavassori Vittorio, Cavallo Giovanna, Casagrande Federica, Vastola Francesca, Magli Alessandro, Franzin Alberto, Basso Umberto, Villa Eugenio
Department of Radiochemotherapy, San Raffaele Hospital Scientific Institute, Milan, Italy.
Cancer. 2004 Mar 15;100(6):1221-9. doi: 10.1002/cncr.20074.
The current analysis of outcomes in a large series of adult patients with intracranial ependymal tumors contributes to the characterization of the primary prognostic factors and to the therapeutic management of this rare disease, for which limited information is available in the literature.
The authors analyzed data on patient and tumor characteristics, treatment, and survival in a series of 70 patients age > 17 years with pathologic diagnoses of brain ependymal tumors from 4 institutions.
The 5- and 10-year overall survival (OS) rates (+/- standard errors) were 67% +/- 6% and 50% +/- 8%, respectively. The 5- and 10-year failure-free survival (FFS) rates were 43% +/- 7% and 24% +/- 6%, respectively. Younger age and infratentorial tumor location were associated with longer survival. Among patients with Grade 2 ependymoma (n = 51), 21 (41%) received no postsurgical treatment. These 21 patients had a 5-year OS rate of 78% +/- 10% and a 10-year OS rate of 68% +/- 13%; the 5- and 10-year FFS rates for these patients were 47% +/- 12% and 12% +/- 11%, respectively. Twenty-six patients with Grade 2 ependymoma (51%) received postoperative radiotherapy (RT). These 26 patients had a 5-year OS rate of 71% +/- 9% and a 10-year OS rate of 59% +/- 11%; the 5- and 10-year FFS rates for these patients were 54% +/- 10% and 34% +/- 10%, respectively. Among patients with Grade 2 ependymoma, neither OS nor FFS differed significantly between those who did not receive postoperative RT and those who did; however, these two groups were heterogeneous with respect to prognostic factors. On multivariate analysis, RT use exhibited a trend toward improved OS and was significantly predictive of improved FFS.
The current analysis does not rule out the possibility that deferral of RT at the time of recurrence could have a detrimental effect on FFS or OS in patients with Grade 2 ependymoma, regardless of the degree of ablation. The role of postoperative RT for patients who undergo imaging-based macroscopic total resection remains to be addressed.
目前对大量成年颅内室管膜瘤患者的预后分析有助于明确主要预后因素，并为这种罕见疾病的治疗管理提供依据，而关于该疾病的文献资料有限。
作者分析了来自4家机构的70例年龄大于17岁、经病理诊断为脑室管膜瘤患者的患者及肿瘤特征、治疗及生存数据。
5年和10年总生存率（±标准误）分别为67%±6%和50%±8%。5年和10年无失败生存率分别为43%±7%和24%±6%。年龄较小和幕下肿瘤位置与较长生存期相关。在2级室管膜瘤患者（n = 51）中，21例（41%）未接受术后治疗。这21例患者的5年总生存率为78%±10%，10年总生存率为68%±13%；这些患者的5年和10年无失败生存率分别为47%±12%和12%±11%。26例2级室管膜瘤患者（51%）接受了术后放疗（RT）。这26例患者的5年总生存率为71%±9%，10年总生存率为59%±11%；这些患者的5年和10年无失败生存率分别为54%±10%和34%±10%。在2级室管膜瘤患者中，未接受术后放疗者和接受术后放疗者的总生存率和无失败生存率均无显著差异；然而，这两组在预后因素方面存在异质性。多因素分析显示，使用放疗有改善总生存的趋势，且显著预测无失败生存的改善。
目前的分析不排除2级室管膜瘤患者复发时推迟放疗可能对无失败生存率或总生存率产生不利影响的可能性，无论切除程度如何。对于接受基于影像学的宏观全切的患者，术后放疗的作用仍有待探讨。
