Department of Neurosurgery, Schwabing Academic Teaching Hospital, Munich, Germany.
BMC Cancer. 2014 Feb 21;14:115. doi: 10.1186/1471-2407-14-115.
Adult brainstem gliomas are rare primary brain tumors (<2% of gliomas). The goal of this study was to analyze clinical, prognostic and therapeutic factors in a large series of histologically proven brainstem gliomas.
Between 1997 and 2007, 104 patients with a histologically proven brainstem glioma were retrospectively analyzed. Data about clinical course of disease, neuropathological findings and therapeutic approaches were analyzed.
The median age at diagnosis was 41 years (range 18-89 years), median KPS before any operative procedure was 80 (range 20-100) and median survival for the whole cohort was 18.8 months. Histopathological examinations revealed 16 grade I, 31 grade II, 42 grade III and 14 grade IV gliomas. Grading was not possible in 1 patient. Therapeutic concepts differed according to the histopathology of the disease. Median overall survival for grade II tumors was 26.4 months, for grade III tumors 12.9 months and for grade IV tumors 9.8 months. On multivariate analysis the relative risk to die increased with a KPS ≤ 70 by factor 6.7, with grade III/IV gliomas by the factor 1.8 and for age ≥ 40 by the factor 1.7. External beam radiation reduced the risk to die by factor 0.4.
Adult brainstem gliomas present with a wide variety of neurological symptoms and postoperative radiation remains the cornerstone of therapy with no proven benefit of adding chemotherapy. Low KPS, age ≥ 40 and higher tumor grade have a negative impact on overall survival.
成人脑干胶质瘤是罕见的原发性脑肿瘤（<2%的胶质瘤）。本研究的目的是分析大量组织学证实的脑干胶质瘤患者的临床、预后和治疗因素。
1997 年至 2007 年间，回顾性分析了 104 例经组织学证实的脑干胶质瘤患者。分析了疾病的临床过程、神经病理学发现和治疗方法的数据。
诊断时的中位年龄为 41 岁（范围 18-89 岁），任何手术前的中位 KPS 为 80（范围 20-100），整个队列的中位生存期为 18.8 个月。组织病理学检查显示 16 级 I、31 级 II、42 级 III 和 14 级 IV 胶质瘤。1 例患者分级不可行。治疗方案根据疾病的组织病理学而有所不同。2 级肿瘤的中位总生存期为 26.4 个月，3 级肿瘤为 12.9 个月，4 级肿瘤为 9.8 个月。多变量分析显示，KPS≤70 的相对死亡风险增加 6.7 倍，3/4 级胶质瘤的相对死亡风险增加 1.8 倍，年龄≥40 岁的相对死亡风险增加 1.7 倍。外照射可降低死亡风险，降低系数为 0.4。
成人脑干胶质瘤表现出多种神经症状，术后放疗仍是治疗的基石，联合化疗并无明确获益。KPS 较低、年龄≥40 岁和肿瘤分级较高对总生存期有负面影响。
