Shweikeh Faris, Quinsey Carolyn, Murayi Roger, Randle Ryan, Nuño Miriam, Krieger Mark D, Patrick Johnson J
Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd. Ste. A6600, Los Angeles, CA, 90048, USA.
Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA.
Childs Nerv Syst. 2017 Aug;33(8):1357-1365. doi: 10.1007/s00381-017-3433-y. Epub 2017 May 8.
Tumors of the spine in children are rare, and further clinical description is necessary.
This study investigated epidemiology, interventions, and outcomes of pediatric patients with spine and spinal cord tumors.
The National Inpatient Sample and Kids' Inpatient Database were used for the study. Outcomes were studied, and bivariate significant trends were analyzed in a multivariate setting.
Analysis of 2870 patients between 2000 and 2009 found a median age of diagnosis of 11 years (Tables 1 and 2). Most were white (65.2%) and had private insurance (62.3%), and 46.8% of procedures were emergent operations. Treatment occurred at teaching (93.6%) and non-children's hospitals (81.1%). Overall mortality rate was 1.7%, non-routine discharges occurred at a rate 19.9%, complications at 21.1%, and average total charges were $66,087. A majority of patients (87.5%) had no intervention, and of those patients receiving treatment, 78.2% underwent surgery and 23.1% had radiotherapy. Treatment with surgery alone increased significantly over time (p < 0.0001). Odds ratio (OR) of mortality was significantly higher in 2006 (OR 3.5) and 2009 (OR 2.6) when compared to 2000. Complications (OR 7.9) and disease comorbidities (OR 1.5) were associated with significantly increased odds of mortality.
Hospital characteristics, length of stay, and charges remained relatively unchanged. In recent years, there has been a decreasing incidence of spine and spinal cord tumors in children. Notably, a higher mortality rate is evident over time in addition to an increase in the proportion of patients undergoing surgery. The high percentage of emergent operations suggests a weak recognition of spine tumors in children and should prompt a call for increased awareness of this cancer. In spite of these findings, lack of tumor type identification was a limitation to this study.
儿童脊柱肿瘤罕见，有必要进行进一步的临床描述。
本研究调查了患有脊柱和脊髓肿瘤的儿科患者的流行病学、干预措施及治疗结果。
使用国家住院样本和儿童住院数据库进行研究。对结果进行了研究，并在多变量环境中分析了双变量显著趋势。
对2000年至2009年间的2870例患者进行分析发现，诊断的中位年龄为11岁（表1和表2）。大多数患者为白人（65.2%），拥有私人保险（62.3%），46.8%的手术为急诊手术。治疗在教学医院（93.6%）和非儿童医院（81.1%）进行。总体死亡率为1.7%，非常规出院率为19.9%，并发症发生率为21.1%，平均总费用为66,087美元。大多数患者（87.5%）未接受干预，在接受治疗的患者中，78.2%接受了手术，23.1%接受了放疗。单纯手术治疗随时间显著增加（p < 0.0001）。与2000年相比，2006年（比值比3.5）和2009年（比值比2.6）的死亡率比值比显著更高。并发症（比值比7.9）和疾病合并症（比值比1.5）与死亡率显著增加相关。
医院特征、住院时间和费用保持相对不变。近年来，儿童脊柱和脊髓肿瘤的发病率有所下降。值得注意的是，随着时间的推移，死亡率明显更高，同时接受手术的患者比例也有所增加。急诊手术的高比例表明对儿童脊柱肿瘤的认识不足，应促使人们提高对这种癌症的认识。尽管有这些发现，但缺乏肿瘤类型识别是本研究的一个局限性。
