Baylor College of Medicine, BCM368, One Baylor Plaza, Houston, TX 77030, USA.
J Neurooncol. 2012 Mar;107(1):139-46. doi: 10.1007/s11060-011-0718-y. Epub 2011 Oct 1.
Little is known about pediatric spinal cord high grade gliomas (SCHGG) beyond their dismal prognosis. Here, we analyzed the HIT-GBM(®) database for the influence of surgical resection on survival. Between 1991 and 2010 the HIT-GBM group collected data from European children diagnosed with high grade glioma. Patients with the following inclusion criteria were analyzed in this study: astrocytic histology, WHO grade III or IV, age at diagnosis <18 years, and tumor localized to the spinal cord. 28 patients (mean age 11.28 years, 14 male) with primary SCHGG were identified. The tumor sizes were measured by the span across adjacent vertebrae and varied greatly (range: 1-20, median: 4). Histology was classified as WHO grade III in 15 and grade IV in 13 tumors. Of note, the four largest tumors identified were WHO grade III. Surgery was classified as complete resection (n = 6), subtotal resection (STR) (n = 7), partial resection (n = 12) or biopsy only (n = 3). 27 patients received chemotherapy, 22 of which also received radiation. With the mean follow-up time of 2.88 (SD ± 2.95) years, 14 patients were still alive resulting in a median overall survival of 2.5 years (SE ± 1.6). The positive prognostic indicators for overall survival were: age younger than 5 years (P = 0.047), WHO grade III (P = 0.046), absence of necrosis (P = 0.025) and gross total resection (GTR) (P = 0.012). The prognosis of SCHGG might not be as miserable as generally assumed. GTR is of benefit. Larger data sets and meta-analysis are necessary to identify patient sub-groups.
对于小儿脊髓高级别胶质瘤（SCHGG），除了预后不良外，人们知之甚少。在这里，我们分析了 HIT-GBM（®）数据库中手术切除对生存的影响。1991 年至 2010 年期间，HIT-GBM 组从欧洲诊断为高级别胶质瘤的儿童中收集数据。本研究分析了符合以下纳入标准的患者：星形细胞瘤组织学、世界卫生组织（WHO）分级 III 或 IV 级、诊断时年龄<18 岁、肿瘤局限于脊髓。共确定了 28 例（平均年龄 11.28 岁，14 名男性）原发性 SCHGG 患者。肿瘤大小通过相邻椎骨的跨度测量，差异很大（范围：1-20，中位数：4）。组织学分类为 WHO 分级 III 级 15 例，分级 IV 级 13 例。值得注意的是，确定的四个最大肿瘤为 WHO 分级 III 级。手术分类为完全切除（n = 6）、次全切除（STR）（n = 7）、部分切除（n = 12）或仅活检（n = 3）。27 例患者接受了化疗，其中 22 例还接受了放疗。中位随访时间为 2.88 年（SD ± 2.95 年），14 例患者仍存活，总生存期中位数为 2.5 年（SE ± 1.6 年）。总生存期的阳性预后指标为：年龄<5 岁（P = 0.047）、WHO 分级 III 级（P = 0.046）、无坏死（P = 0.025）和大体全切除（GTR）（P = 0.012）。SCHGG 的预后可能不像人们普遍认为的那么悲惨。GTR 有益。需要更大的数据集和荟萃分析来确定患者亚组。
