Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
Pediatr Neurol. 2017 Nov;76:27-36. doi: 10.1016/j.pediatrneurol.2017.08.006. Epub 2017 Aug 18.
Children with central nervous system (CNS) tumours may present with a multitude of symptoms, ranging from elevated intracranial pressure to focal neurological deficit. In everyday practice, some signs may be misleading, thereby causing prolonged prediagnostic symptomatic intervals. Prediagnostic symptomatic intervals are longer for pediatric brain tumors than for other childhood malignancies. This study evaluated prediagnostic symptomatic intervals and parental and diagnostic intervals for pediatric patients with CNS tumours in Austria. It also considered socioeconomic factors.
Patients ≤ 19 years of age treated at the Medical University of Vienna and diagnosed during the years 2008 to 2013 were included. Patients diagnosed incidentally or by screening were excluded.
Two hundred twelve consecutive patients were included in the study. They reflected the expected spectrum of CNS tumors. Patients presented with a median of five symptoms at diagnosis, most frequently with signs of elevated intracranial pressure. The median prediagnostic symptomatic interval was 60 days (0 days to seven years), the median parental interval was 30 days (0 days to 6.7 years), and the median diagnostic interval was three days (0 days to 6.5 years). In spinal tumors alone (n = 7), the median prediagnostic symptomatic interval was 70 days (ten days to seven years), and three of seven patients had a prediagnostic symptomatic interval longer than 320 days. Young age, higher tumor grade, and ataxia were associated with a shorter prediagnostic symptomatic interval. Localization in the supratentorial midline, histology of craniopharyngioma, and endocrine symptoms prolonged the prediagnostic symptomatic interval. There was a clear trend for longer prediagnostic symptomatic interval in non-native speakers.
Results are comparable to other industrialized countries. However, long delays in diagnosis of central nervous system tumors still occur, urging increased awareness.
中枢神经系统 (CNS) 肿瘤患儿可能表现出多种症状，从颅内压升高到局灶性神经功能缺损。在日常实践中，一些症状可能会产生误导，从而导致诊断前症状持续时间延长。儿科脑肿瘤的诊断前症状持续时间长于其他儿童恶性肿瘤。本研究评估了奥地利 CNS 肿瘤患儿的诊断前症状间隔时间以及父母和诊断间隔时间，并考虑了社会经济因素。
纳入 2008 年至 2013 年在维也纳医科大学接受治疗且诊断为 CNS 肿瘤的年龄 ≤ 19 岁的患者。排除偶然诊断或筛查诊断的患者。
本研究共纳入 212 例连续患者，反映了 CNS 肿瘤的预期谱。患者在诊断时出现中位数为 5 个症状，最常见的是颅内压升高的迹象。中位诊断前症状间隔时间为 60 天（0 天至 7 年），中位父母间隔时间为 30 天（0 天至 6.7 年），中位诊断间隔时间为 3 天（0 天至 6.5 年）。仅在脊柱肿瘤中（n=7），中位诊断前症状间隔时间为 70 天（10 天至 7 年），7 例中有 3 例诊断前症状间隔时间长于 320 天。年龄较小、肿瘤分级较高和共济失调与较短的诊断前症状间隔时间相关。幕上中线定位、颅咽管瘤组织学和内分泌症状延长了诊断前症状间隔时间。非母语者的诊断前症状间隔时间有延长的明显趋势。
结果与其他工业化国家相当。然而，中枢神经系统肿瘤的诊断仍存在较长的延迟，这迫切需要提高认识。
