Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143-0112, USA.
J Clin Neurosci. 2013 Jun;20(6):808-12. doi: 10.1016/j.jocn.2012.08.003. Epub 2013 Apr 25.
Choroid plexus papillomas are rare neuroepithelial tumors found mainly in children. Although well studied in the pediatric population, there is a paucity of literature focusing specifically on adults. We sought to assess the relative advantage of gross total resection (GTR) and further characterize the natural history of this disease in adults. A comprehensive PubMed search was performed to identify adults who underwent surgical resection for choroid plexus papillomas with clearly reported age, tumor location, and extent of resection. Kaplan-Meier analysis was used to assess progression-free survival (PFS) and overall survival (OS). Multivariate analysis was performed using Cox proportional hazards models. A total of 193 patients were identified with a mean age of 39.9 ± 1.1 years. GTR was achieved in 72% of patients with subtotal resection (STR) in 28%. GTR was associated with a significant increase in both PFS (p = 0.015) and OS (p = 0.004) compared to STR. In a multivariate Cox proportional hazards model we found that only GTR was associated with recurrence (hazard ratio [HR] = 0.47, 95% confidence interval [CI] 0.25-0.90), while both age (HR = 1.03, 95% CI 1.00-1.05) and GTR (HR = 0.36, 95% CI 0.17-0.78) were associated with OS. Interestingly, our observed recurrence and death rates were higher than those in previously published studies. These findings demonstrate the benefit of GTR for the treatment of choroid plexus papillomas in adults. Our analysis suggests that these lesions are not as indolent as previously thought and while GTR is preferred, it is not always curative.
脉络丛乳头状瘤是一种罕见的神经上皮肿瘤，主要发生在儿童中。虽然在儿科人群中得到了很好的研究，但针对成人的专门文献相对较少。我们旨在评估大体全切除（GTR）的相对优势，并进一步描述这种疾病在成人中的自然史。我们进行了全面的 PubMed 检索，以确定接受手术切除脉络丛乳头状瘤的成年人，这些患者的年龄、肿瘤位置和切除范围均有明确报告。采用 Kaplan-Meier 分析评估无进展生存期（PFS）和总生存期（OS）。使用 Cox 比例风险模型进行多变量分析。共确定了 193 例患者，平均年龄为 39.9±1.1 岁。72%的患者行 GTR，28%的患者行次全切除（STR）。与 STR 相比，GTR 显著提高了 PFS（p=0.015）和 OS（p=0.004）。在多变量 Cox 比例风险模型中，我们发现仅 GTR 与复发相关（风险比 [HR] = 0.47，95%置信区间 [CI] 0.25-0.90），而年龄（HR = 1.03，95% CI 1.00-1.05）和 GTR（HR = 0.36，95% CI 0.17-0.78）均与 OS 相关。有趣的是，我们观察到的复发率和死亡率高于以前发表的研究。这些发现表明 GTR 对成人脉络丛乳头状瘤的治疗有益。我们的分析表明，这些病变并不像以前认为的那样惰性，虽然 GTR 是首选，但它并不总是能治愈。
