与儿童颅内生殖细胞肿瘤瘤内出血相关的预后因素。

Prognostic factors related to intratumoral hemorrhage in pediatric intracranial germ cell tumors.

机构信息

Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC.

College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, ROC.

出版信息

J Chin Med Assoc. 2019 Feb;82(2):133-137. doi: 10.1097/JCMA.0000000000000015.

DOI:10.1097/JCMA.0000000000000015

PMID:30839504

Abstract

BACKGROUND

Certain types of pediatric intracranial germ cell tumors (PIGCTs) are prone to intratumoral hemorrhaging (TH) and associated with poor survival outcome. However, the impact of TH on the functional prognosis of patients with PIGCTs has not been well studied. This study aimed to evaluate the clinical and MR findings in PIGCT patients with TH to identify the factors related to patient survival and functional outcome.

METHODS

This study included 17 patients diagnosed with PIGCT and TH between 2002 and 2016 and evaluated TH-associated clinical and MR findings. The modified Rankin scale (mRS) was used to evaluate functional outcome, which was poor when mRS ≧ 3. The volumes of hematomas and tumors were manually tracked within each brain magnetic resonance imaging slice.

RESULTS

Among the 17 patients, 6 (35.3%) died and 9 (52.9%) had poor functional outcome. Regarding the functional outcome, the mean hematoma volume to tumor volume ratio (HTVR) was 8.5 ± 3.9% in the favorable outcome group and 42.3 ± 27.8% in the poor outcome group (p = 0.001). For the survival outcome, the mean HTVR was 15.7 ± 16.1% in the living group and 46.0 ± 31.5% in the deceased group (p = 0.016). The cutoff point of the receiver operating characteristics curve for HTVR to predict death and poor functional outcome was 19.27% and 16.8%, respectively.

CONCLUSION

Our study demonstrated that patients with larger HTVR had significantly worse functional and survival outcomes than those with smaller HTVR. We suggest that early and aggressive treatment for PIGCTs in patients with large HTVR can improve their long-term prognosis.

摘要

背景

某些类型的小儿颅内生殖细胞肿瘤（PIGCT）容易发生肿瘤内出血（TH），并与不良的生存结局相关。然而，TH 对 PIGCT 患者的功能预后的影响尚未得到很好的研究。本研究旨在评估伴有 TH 的 PIGCT 患者的临床和磁共振成像（MR）表现，以确定与患者生存和功能结局相关的因素。

方法

本研究纳入了 2002 年至 2016 年间诊断为 PIGCT 合并 TH 的 17 例患者，并评估了 TH 相关的临床和 MR 表现。采用改良 Rankin 量表（mRS）评估功能结局，mRS≧3 为预后不良。手动在每个脑磁共振成像切片内追踪血肿和肿瘤的体积。

结果

在 17 例患者中，6 例（35.3%）死亡，9 例（52.9%）功能预后不良。就功能结局而言，预后良好组的血肿体积与肿瘤体积比值（HTVR）平均值为 8.5±3.9%，而预后不良组为 42.3±27.8%（p=0.001）。对于生存结局，生存组的 HTVR 平均值为 15.7±16.1%，死亡组为 46.0±31.5%（p=0.016）。HTVR 预测死亡和功能不良结局的受试者工作特征曲线的截断点分别为 19.27%和 16.8%。