Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili Chongwen District, Beijing 100050, People's Republic of China.
Neurosurg Rev. 2013 Apr;36(2):311-9; discussion 319-20. doi: 10.1007/s10143-012-0428-8. Epub 2012 Nov 9.
The purpose of this study is to investigate the patient characteristics and clinical outcomes of children with pediatric brainstem glioma. Between 2004 and 2009, a total of 42 children were diagnosed with brainstem gliomas at the Neurosurgical Center of Beijing Tiantan Hospital, China. A retrospective study including the 33 patients of this cohort with complete follow-up was conducted in an attempt to better understand clinical outcomes following multidisciplinary treatment modalities for pediatric brainstem gliomas. Investigational variables including clinical presentations, anatomical distribution, radiological findings, and clinical outcomes were analyzed. Survival time difference was computed using a Kaplan-Meier method with a log-rank test between groups. The Cox proportional hazards regression model was utilized in the multivariate analysis to determine the independent prognostic factors. Overall median survival of the entire series of patients was 11 months with a 1-year actuarial survival rate of 43.6 %. In nine patients who received no treatment after diagnosis, all patients expired within 8 months with a median time of 3.5 months. On univariate analysis, the following variables including older age at diagnosis, higher Karnofsky Performance Status score at diagnosis, the lower pathological grade, surgical resection modality, increasing diagnostic latency, and focal growth pattern were associated with better survival. On multivariate analysis, only the last two variables were associated with survival advantage. Focal pediatric brainstem gliomas amenable to a surgical resection are likely to achieve a prolonged survival. Clinical trials on larger number of patients are of importance in further understanding this spectrum of devastating diseases.
本研究旨在探讨儿童脑干胶质瘤患者的临床特征和预后。2004 年至 2009 年，中国北京天坛医院神经外科中心共诊断出 42 例脑干胶质瘤患儿。本研究对该队列中 33 例具有完整随访资料的患者进行回顾性研究，以更好地了解多学科治疗模式治疗儿童脑干胶质瘤的临床结果。分析了包括临床表现、解剖分布、影像学发现和临床结果等调查变量。采用 Kaplan-Meier 方法和对数秩检验对组间生存时间差异进行计算。利用 Cox 比例风险回归模型对多变量分析确定独立预后因素。整组患者的总体中位生存时间为 11 个月，1 年生存率为 43.6%。在 9 例诊断后未接受治疗的患者中，所有患者在 8 个月内死亡，中位时间为 3.5 个月。单因素分析显示，诊断时年龄较大、诊断时 Karnofsky 表现状态评分较高、病理分级较低、手术切除方式、诊断延迟时间延长和局灶性生长模式与生存时间延长有关。多因素分析显示，只有后两个变量与生存优势相关。能够进行手术切除的局灶性儿童脑干胶质瘤可能会获得更长的生存时间。在进一步了解这一系列毁灭性疾病方面，对更多患者进行临床试验具有重要意义。
