Zhang Yi, Zhu Huijuan, Deng Kan, Ma Wenbin, Wang Yu, Sun Jian, Lian Xin, Pan Hui, Wang Renzhi, Yao Yong
Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China.
Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China.
World Neurosurg. 2018 Apr;112:e229-e239. doi: 10.1016/j.wneu.2018.01.028. Epub 2018 Jan 8.
The biopsy is recognized as the most accurate method to determine the histologic characterization of sellar germ cell tumors. It is difficult to evaluate the prognosis before histologic confirmation.
This study aimed to evaluate the independent prognostic risk factors of patients with sellar germ cell tumors (GCTs).
From January 2008 to December 2015, 61 patients who were histologically diagnosed as having sellar GCTs were followed up and were included in this retrospective study.
Of 61 patients in this study, 40 (65.6%), 10 (16.4%), and 11 (18.0%) were diagnosed as having pure germinomas, germinomas with syncytiotrophoblastic giant cells and non-germinomatous GCTs (NGGCTs), respectively. The patients with pure germinomas had a significantly better overall survival time than did those with NGGCT (56.47 ± 3.01 months vs. 43.09 ± 10.58 months; P = 0.01). Multivariate analysis showed that the independent poor prognostic risk factors of patients with sellar GCTs were diameters >15 mm (odds ratio [OR], 7.40; 95% confidence interval [CI], 2.01-27.19), octamer-binding transcription positivity (OR, 5.97; 95% CI, 1.40-25.48), and NGGCT (OR, 11.88; 95% CI, 2.37-59.50), whereas the combination of chemotherapy and radiotherapy was associated with a better prognosis (OR, 0.15; 95% CI, 0.04-0.55).
Diameter >15 mm, octamer-binding transcription positivity, or NGGCT was associated with a poorer prognosis for patients with sellar GCTs, whereas the combination of chemotherapy and radiotherapy was associated with a better prognosis.
活检被认为是确定鞍区生殖细胞肿瘤组织学特征的最准确方法。在组织学确诊之前很难评估预后。
本研究旨在评估鞍区生殖细胞肿瘤(GCTs)患者的独立预后危险因素。
2008年1月至2015年12月,对61例经组织学诊断为鞍区GCTs的患者进行随访,并纳入本回顾性研究。
本研究的61例患者中,分别有40例(65.6%)、10例(16.4%)和11例(18.0%)被诊断为纯生殖细胞瘤、伴有合体滋养层巨细胞的生殖细胞瘤和非生殖细胞性GCTs(NGGCTs)。纯生殖细胞瘤患者的总生存时间明显优于NGGCT患者(56.47±3.01个月对43.09±10.58个月;P = 0.01)。多因素分析显示,鞍区GCTs患者独立的不良预后危险因素为直径>15 mm(比值比[OR],7.40;95%置信区间[CI],2.01 - 27.19)、八聚体结合转录阳性(OR,5.97;95% CI,1.40 - 25.48)和NGGCT(OR,11.88;95% CI,2.37 - 59.50),而化疗和放疗联合应用与较好的预后相关(OR,0.15;95% CI,0.04 - 0.55)。
直径>15 mm、八聚体结合转录阳性或NGGCT与鞍区GCTs患者预后较差相关,而化疗和放疗联合应用与较好的预后相关。