Guyotat Jacques, Metellus Philippe, Giorgi Roch, Barrie Marylin, Jouvet Anne, Fevre-Montange Michelle, Chinot Olivier, Durand Anne, Figarella-Branger Dominique
Department of Neurosurgery, Pierre Wertheimer GHE Neurological Hospital, Lyon, France.
Acta Neurochir (Wien). 2009 Aug;151(8):947-60. doi: 10.1007/s00701-009-0417-z. Epub 2009 Jun 5.
This study was undertaken to analyze outcomes and to assess the prognostic impact of age, location, surgery, radiotherapy (RT), and histopathology in a series of adult infratentorial ependymomas.
This was a retrospective study of a population of 106 adult patients with infratentorial ependymomas diagnosed between 1990 and 2004. A central pathological review of all cases was performed. Grading was according to the WHO and Marseille's neograding classifications.
The series consisted of 58 males (54.7%) and 48 females (45.3%) in the age range of 18-82 years. Using the WHO classification, 88 patients (83.0%) had grade II and 18 patients (17.0%) grade III ependymomas. Using the Marseille's neograding system, 91 patients were low-grade and 15 high-grade. Gross total resection was achieved in 66 patients (62.3%). Thirty-seven patients (35.0%) received adjuvant RT. The 5- and 10-year overall survival rates for the entire cohort were 86.1% and 80.5%, respectively. On multivariate analysis, a preoperative Karnofski performance status score > 80, no recessus lateral extension and a low histological grade (Marseille's grading) were associated with a longer overall survival. The 5- and 10-year progression-free survival rates for the entire cohort were 70.8% and 57.7%, respectively. On multivariate analysis, no recessus lateral extension, gross total resection and a low histological grade (Marseille's grading) were associated with a longer progression-free survival. Adjuvant RT was significantly associated with a better overall and progression-free survival in incompletely resected WHO grade II ependymomas.
This study highlights the key role of histology in the clinical outcome and the fact that gross total resection is a main prognostic factor and the treatment of choice for posterior fossa ependymomas. The use of adjuvant RT in patients with incompletely resected WHO grade II ependymomas appears beneficial, but its effect on high-grade tumors remains to be determined.
本研究旨在分析一系列成人幕下室管膜瘤的治疗结果，并评估年龄、肿瘤位置、手术、放疗（RT）及组织病理学对预后的影响。
这是一项对1990年至2004年间确诊的106例成人幕下室管膜瘤患者的回顾性研究。对所有病例进行了中心病理复查。分级依据世界卫生组织（WHO）和马赛新分级分类系统。
该系列包括58例男性（54.7%）和48例女性（45.3%），年龄在18 - 82岁之间。根据WHO分类，88例患者（83.0%）为II级室管膜瘤，18例患者（17.0%）为III级室管膜瘤。根据马赛新分级系统，91例为低级别，15例为高级别。66例患者（62.3%）实现了肿瘤全切。37例患者（35.0%）接受了辅助放疗。整个队列的5年和10年总生存率分别为86.1%和80.5%。多因素分析显示，术前卡诺夫斯基功能状态评分>80、无侧隐窝延伸以及低组织学分级（马赛分级）与较长的总生存期相关。整个队列的5年和10年无进展生存率分别为70.8%和57.7%。多因素分析显示，无侧隐窝延伸、肿瘤全切以及低组织学分级（马赛分级）与较长的无进展生存期相关。辅助放疗与WHO II级室管膜瘤不完全切除患者更好的总生存期和无进展生存期显著相关。
本研究强调了组织学在临床结果中的关键作用，以及肿瘤全切是后颅窝室管膜瘤主要预后因素和首选治疗方法这一事实。对于WHO II级室管膜瘤不完全切除的患者，使用辅助放疗似乎有益，但其对高级别肿瘤的影响仍有待确定。
