肿瘤组织学对原发性脊髓髓内肿瘤可切除性和神经结局的影响：单中心 102 例患者经验。
Impact of tumor histology on resectability and neurological outcome in primary intramedullary spinal cord tumors: a single-center experience with 102 patients.
机构信息
Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
出版信息
Neurosurgery. 2011 Jan;68(1):188-97; discussion 197. doi: 10.1227/NEU.0b013e3181fe3794.
BACKGROUND
Surgical outcomes for intramedullary spinal cord tumors are affected by many variables including tumor histology and preoperative neurological function.
OBJECTIVE
To analyze the impact of tumor histology on neurological outcome in primary intramedullary spinal cord tumors.
METHODS
A retrospective review of 102 consecutive patients with intramedullary spinal cord tumors treated at a single institution between January 1998 and March 2009.
RESULTS
Ependymomas were the most common tumors with 55 (53.9%), followed by 21 astrocytomas (20.6%), 12 hemangioblastomas (11.8%), and 14 miscellaneous tumors (13.7%). Gross total resection was achieved in 50 ependymomas (90.9%), 3 astrocytomas (14.3%), 11 hemangioblastomas (91.7%), and 12 miscellaneous tumors (85.7%). At a mean follow-up of 41.8 months (range, 1-132 months), we observed recurrences in 4 ependymoma cases (7.3%), 10 astrocytoma cases (47.6%), 1 miscellaneous tumor case (7.1%), and no recurrence in hemangioblastoma cases. When analyzed by tumor location, there was no difference in neurological outcomes (P = .66). At the time of their last follow-up visit, 11 patients (20%) with an ependymoma improved, 38 (69%) remained the same, and 6 (10.9%) worsened. In patients with an astrocytoma, 1 (4.8%) improved, 10 (47.6%) remained the same, and 10 (47.6%) worsened. One patient (8.3%) with a hemangioblastoma improved and 11 (91.7%) remained the same. No patient with a hemangioblastoma worsened. In the miscellaneous tumor group, 2 (14.3%) improved, 10 (71.4%) remained the same, and 2 (14.3%) worsened. Preoperative neurological status (P = .02), tumor histology (P = .005), and extent of resection (P < .0001) were all predictive of functional neurological outcomes.
CONCLUSION
Tumor histology is the most important predictor of neurological outcome after surgical resection because it predicts resectability and recurrence.
背景
脊髓髓内肿瘤的手术结果受多种因素影响，包括肿瘤组织学和术前神经功能。
目的
分析原发性脊髓髓内肿瘤的肿瘤组织学对神经功能预后的影响。
方法
对 1998 年 1 月至 2009 年 3 月在一家医疗机构接受治疗的 102 例连续脊髓髓内肿瘤患者进行回顾性分析。
结果
室管膜瘤最常见，有 55 例（53.9%），其次是星形细胞瘤 21 例（20.6%）、血管母细胞瘤 12 例（11.8%）和其他肿瘤 14 例（13.7%）。50 例室管膜瘤（90.9%）、3 例星形细胞瘤（14.3%）、11 例血管母细胞瘤（91.7%）和 12 例其他肿瘤（85.7%）达到大体全切除。平均随访 41.8 个月（范围 1-132 个月），观察到 4 例室管膜瘤病例（7.3%）、10 例星形细胞瘤病例（47.6%）、1 例其他肿瘤病例（7.1%）复发，血管母细胞瘤病例无复发。按肿瘤位置分析，神经功能预后无差异（P =.66）。末次随访时，11 例室管膜瘤患者（20%）改善，38 例（69%）保持不变，6 例（10.9%）恶化。星形细胞瘤患者中，1 例（4.8%）改善，10 例（47.6%）保持不变，10 例（47.6%）恶化。1 例血管母细胞瘤患者（8.3%）改善，11 例（91.7%）保持不变。无血管母细胞瘤患者恶化。在其他肿瘤组中，2 例（14.3%）改善，10 例（71.4%）保持不变，2 例（14.3%）恶化。术前神经功能状态（P =.02）、肿瘤组织学（P =.005）和切除程度（P <.0001）均是神经功能预后的预测因素。
结论
肿瘤组织学是手术切除后神经功能预后的最重要预测因素，因为它预测可切除性和复发率。
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