McGuire Courtney S, Sainani Kristin L, Fisher Paul Graham
Department of Neurology, Stanford University, Palo Alto, California, USA.
Pediatr Blood Cancer. 2009 Jan;52(1):65-9. doi: 10.1002/pbc.21806.
Studies have suggested that supratentorial ependymomas have better survival than infratentorial tumors, with spinal tumors having the best prognosis, but these data have been based on small samples. Using a population-based registry of ependymomas, we analyzed how age, gender, location, race and radiotherapy influence survival in children.
We queried the Surveillance Epidemiology End Results database (SEER-17) from 1973 to 2003, strictly defining ependymomas by histology. Site codes were used to distinguish between supratentorial, infratentorial, and spinal tumors when available. Outcomes were compared by location, age, gender, race and radiotherapy, using Kaplan-Meier analysis and logrank tests. Cox regression was completed, incorporating all significant covariates from univariate analysis.
Six hundred thirty-five children were identified with an overall 5-year survival of 57.1 +/- standard error (SE) 2.3%. Increasing age was associated with improved survival (P < 0.0001). Five-year survival by location was 59.5 +/- SE 5.5% supratentorial, 57.1 +/- SE 4.1% infratentorial and 86.7 +/- SE 5.2% spinal. Radiotherapy of the infratentorial tumors resulted in significantly improved survival in both univariate analysis (logrank P < 0.018) and multivariate analysis restricted to this tumor location (P = 0.033). Using multivariate analysis that incorporated all tumor locations, age (P < 0.001) and location (P = 0.020) were significant predictors for survival.
Age and location independently influence survival in ependymoma. Spinal tumors are associated with a significantly better prognosis than both supratentorial and infratentorial tumors, and may represent a distinct biological entity. Radiotherapy appears beneficial for survival in patients with infratentorial ependymoma.
研究表明幕上室管膜瘤的生存率高于幕下肿瘤，脊髓肿瘤预后最佳，但这些数据基于小样本。我们利用基于人群的室管膜瘤登记数据，分析年龄、性别、位置、种族和放疗如何影响儿童的生存率。
我们查询了1973年至2003年的监测、流行病学和最终结果数据库（SEER - 17），通过组织学严格定义室管膜瘤。如有可用的部位编码，则用于区分幕上、幕下和脊髓肿瘤。使用Kaplan - Meier分析和对数秩检验，按位置、年龄、性别、种族和放疗情况比较结果。进行Cox回归分析，纳入单变量分析中所有显著的协变量。
共确定635例儿童患者，总体5年生存率为57.1%±标准误（SE）2.3%。年龄增加与生存率提高相关（P < 0.0001）。按位置划分的5年生存率为：幕上59.5%±SE 5.5%，幕下57.1%±SE 4.1%，脊髓86.7%±SE 5.2%。幕下肿瘤放疗在单变量分析（对数秩P < 0.018）和仅限于该肿瘤位置的多变量分析中（P = 0.033）均使生存率显著提高。在纳入所有肿瘤位置的多变量分析中，年龄（P < 0.001）和位置（P = 0.020）是生存率的显著预测因素。
年龄和位置独立影响室管膜瘤的生存率。脊髓肿瘤的预后明显优于幕上和幕下肿瘤，可能代表一种独特的生物学实体。放疗似乎对幕下室管膜瘤患者的生存有益。
