Azad Tej D, Pendharkar Arjun V, Pan James, Huang Yuhao, Li Amy, Esparza Rogelio, Mehta Swapnil, Connolly Ian D, Veeravagu Anand, Campen Cynthia J, Cheshier Samuel H, Edwards Michael S B, Fisher Paul G, Grant Gerald A
Departments of1Neurosurgery and.
2Neurology, Stanford University School of Medicine, Stanford, California.
J Neurosurg Pediatr. 2018 Oct;22(4):404-410. doi: 10.3171/2018.4.PEDS17587. Epub 2018 Jul 20.
Pediatric spinal astrocytomas are rare spinal lesions that pose unique management challenges. Therapeutic options include gross-total resection (GTR), subtotal resection (STR), and adjuvant chemotherapy or radiation therapy. With no randomized controlled trials, the optimal management approach for children with spinal astrocytomas remains unclear. The aim of this study was to conduct a systematic review and meta-analysis on pediatric spinal astrocytomas.
The authors performed a systematic review of the PubMed/MEDLINE electronic database to investigate the impact of histological grade and extent of resection on overall survival among patients with spinal cord astrocytomas. They retained publications in which the majority of reported cases included astrocytoma histology.
Twenty-nine previously published studies met the eligibility criteria, totaling 578 patients with spinal cord astrocytomas. The spinal level of intramedullary spinal cord tumors was predominantly cervical (53.8%), followed by thoracic (40.8%). Overall, resection was more common than biopsy, and GTR was slightly more commonly achieved than STR (39.7% vs 37.0%). The reported rates of GTR and STR rose markedly from 1984 to 2015. Patients with high-grade astrocytomas had markedly worse 5-year overall survival than patients with low-grade tumors. Patients receiving GTR may have better 5-year overall survival than those receiving STR.
The authors describe trends in the management of pediatric spinal cord astrocytomas and suggest a benefit of GTR over STR for 5-year overall survival.
小儿脊髓星形细胞瘤是罕见的脊髓病变，带来独特的治疗挑战。治疗选择包括全切除（GTR）、次全切除（STR）以及辅助化疗或放疗。由于缺乏随机对照试验，小儿脊髓星形细胞瘤的最佳治疗方法仍不明确。本研究的目的是对小儿脊髓星形细胞瘤进行系统评价和荟萃分析。
作者对PubMed/MEDLINE电子数据库进行了系统评价，以研究组织学分级和切除范围对脊髓星形细胞瘤患者总生存的影响。他们纳入了大多数报告病例为星形细胞瘤组织学的出版物。
29项先前发表的研究符合纳入标准，共有578例脊髓星形细胞瘤患者。脊髓髓内肿瘤的脊髓节段以颈段为主（53.8%），其次是胸段（40.8%）。总体而言，切除比活检更常见，全切除比次全切除略更常见（39.7%对37.0%）。1984年至2015年期间，报告的全切除和次全切除率显著上升。高级别星形细胞瘤患者的5年总生存率明显低于低级别肿瘤患者。接受全切除的患者可能比接受次全切除的患者有更好的5年总生存率。
作者描述了小儿脊髓星形细胞瘤的治疗趋势，并提示全切除在5年总生存率方面优于次全切除。
