低级别胶质瘤的青少年/青年和儿童患者的临床病理特征和生存比较分析：来自儿童肿瘤学组的报告。
A comparative analysis of clinicopathological features and survival among early adolescents/young adults and children with low-grade glioma: a report from the Children's Oncology Group.
机构信息
Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA.
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
出版信息
J Neurooncol. 2018 Dec;140(3):575-582. doi: 10.1007/s11060-018-2983-5. Epub 2018 Sep 1.
BACKGROUND
For several types of cancer, biological differences and outcome disparities have been documented in adolescents/young adults (AYAs, 15-39 years old) versus children. This study compared clinicopathological features and survival between younger AYAs and children with low-grade glioma (LGG), a common brain tumor among AYAs.
METHODS
This was a secondary analysis of Children's Oncology Group legacy study CCG-9891/POG-9130, which enrolled participants 0-21 years of age with newly-diagnosed LGG treated with surgery alone. For analysis, participants were categorized as children (0-14 years old) or early AYAs (eAYAs, 15-21 years old) and compared on demographics, clinical presentation, tumor characteristics, surgical outcomes, progression-free survival (PFS) and overall survival (OS).
RESULTS
Among 468 children and 50 eAYAs, more eAYAs presented with seizures (34.0% vs. 19.2%; p = 0.015), without other significant differences in clinicopathological features. 5-year PFS rates for children and eAYA were 80.2% (95% confidence interval [95% CI], 76.1-83.7) and 83.0% (95% CI 68.8-91.1), respectively; 5-year OS rates were 97.3% (95% CI 95.2-98.5) and 95.4% (95% CI 82.7-98.8), respectively. Multivariable analysis including all participants showed presence of residual tumor to be an independent predictor of PFS (< 1.5 cm, hazard ratio [HR] 5.93 [95% CI 3.45-10.18]) and (≥ 1.5 cm, HR 8.38 [95% CI 4.75-14.79]) (p < 0.001), while midline-chiasmatic location (HR 9.69 [95% CI 3.05-30.75], p < 0.001) and non-pilocytic astrocytoma histology (HR 6.77 [95% CI 2.35-19.49], p < 0.001) were independent predictors of OS.
CONCLUSION
Unlike several other cancers, LGG has similar presenting features and survival for both eAYAs and children. This support continuing a unified treatment approach and enrollment of eAYAs in pediatric clinical trials for LGGs.
背景
对于几种癌症，已经记录了青少年/年轻人（15-39 岁）与儿童之间的生物学差异和预后差异。本研究比较了低级别胶质瘤（LGG）的年轻 AYA 和儿童之间的临床病理特征和生存情况，LGG 是 AYA 中常见的脑肿瘤。
方法
这是儿童肿瘤学组遗留研究 CCG-9891/POG-9130 的二次分析，该研究纳入了接受单纯手术治疗的新诊断为 LGG 的 0-21 岁参与者。为了分析，将参与者分为儿童（0-14 岁）或早期 AYA（15-21 岁），并在人口统计学、临床表现、肿瘤特征、手术结果、无进展生存期（PFS）和总生存期（OS）方面进行比较。
结果
在 468 名儿童和 50 名 eAYA 中，更多的 eAYA 出现癫痫发作（34.0% vs. 19.2%；p=0.015），但临床病理特征无其他显著差异。儿童和 eAYA 的 5 年 PFS 率分别为 80.2%（95%CI 76.1-83.7）和 83.0%（95%CI 68.8-91.1）；5 年 OS 率分别为 97.3%（95%CI 95.2-98.5）和 95.4%（95%CI 82.7-98.8）。包括所有参与者的多变量分析显示，存在残留肿瘤是 PFS 的独立预测因素（<1.5cm，风险比 [HR]5.93[95%CI 3.45-10.18]）和（≥1.5cm，HR8.38[95%CI 4.75-14.79]）（p<0.001），而中线-视交叉位置（HR9.69[95%CI 3.05-30.75]，p<0.001）和非毛细胞型星形细胞瘤组织学（HR6.77[95%CI 2.35-19.49]，p<0.001）是 OS 的独立预测因素。
结论
与其他几种癌症不同，LGG 在 eAYA 和儿童中具有相似的表现特征和生存情况。这支持继续采用统一的治疗方法，并将 eAYA 纳入 LGG 的儿科临床试验。
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