Department of Neurosurgery, University of California, San Francisco, CA, United States of America.
Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America.
PLoS One. 2019 Sep 25;14(9):e0223051. doi: 10.1371/journal.pone.0223051. eCollection 2019.
Brain tumors are the most common solid malignancy and leading cause of cancer-related deaths in infants. Current epidemiological data is limited by low numbers of reported cases. This study used a population-based approach with analysis of contemporary and historical survival curves to provide up-to-date prognostication.
Observational cohort analysis was performed using the Surveillance, Epidemiology and End Results (SEER) database. Infants with brain tumors diagnosed from 1973 to 2013 were categorized by the most common tumor types (diffuse astrocytic and oligodendroglioma, choroid plexus, embryonal, ependymal, medulloblastoma and pilocytic astrocytoma). The 1, 5 and 10 year survival was stratified by decade, with trends in management and outcomes analyzed.
We identified 2996 affected infants satisfying inclusion criteria. All tumor types, except embryonal and choroid plexus, demonstrated improving survival with time. Infants with embryonal tumors showed a decline in survival from the 1970s to 1990s (p = 0.009), whereas infants with choroid plexus tumors had no change in survival. Infants with ependymal tumors experienced the greatest improvement in survival from 1980s to 1990s and 1990s to 2000s (p = 0.0001, p = 0.01), with 5-year survival probability improving from 28% (95% CI 15-42%) in the 1980s to 77% (95% CI 69-83%) the 2000s. The use of radiation declined from 1970 to 2000 for all tumors; however, radiation treatment for embryonal and ependymal subtypes increased after 2000.
While overall survival for infants with brain tumors has improved from the 1970s onwards, not every tumor type has seen a statistically significant change. Given changes in management and survival, prognostication of infants with brain tumor should be updated.
脑肿瘤是最常见的实体恶性肿瘤，也是婴儿癌症相关死亡的主要原因。目前的流行病学数据受到报告病例数量少的限制。本研究采用基于人群的方法，分析当代和历史生存曲线，提供最新的预后预测。
使用监测、流行病学和最终结果（SEER）数据库进行观察性队列分析。1973 年至 2013 年间诊断为脑肿瘤的婴儿根据最常见的肿瘤类型（弥漫性星形细胞瘤和少突胶质细胞瘤、脉络丛、胚胎性、室管膜、髓母细胞瘤和毛细胞星形细胞瘤）进行分类。按十年分层 1、5 和 10 年生存率，并分析管理和结果的趋势。
我们确定了 2996 名符合纳入标准的受影响婴儿。除胚胎性和脉络丛外，所有肿瘤类型的生存率均随时间推移而提高。胚胎性肿瘤患儿的生存率从 20 世纪 70 年代至 90 年代呈下降趋势（p = 0.009），而脉络丛肿瘤患儿的生存率没有变化。室管膜瘤患儿的生存率从 20 世纪 80 年代至 90 年代和 90 年代至 21 世纪初改善最大（p = 0.0001，p = 0.01），5 年生存率从 20 世纪 80 年代的 28%（95%CI 15-42%）提高到 21 世纪的 77%（95%CI 69-83%）。所有肿瘤的放疗使用率从 20 世纪 70 年代至 2000 年下降；然而，2000 年后胚胎性和室管膜亚型的放疗治疗增加。
尽管自 20 世纪 70 年代以来，脑肿瘤患儿的总体生存率有所提高，但并非所有肿瘤类型的生存率都有统计学意义的变化。鉴于管理和生存的变化，脑肿瘤患儿的预后预测应进行更新。
