Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA.
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 101 The City Drive South, Orange, CA, 92868-3201, USA.
Childs Nerv Syst. 2021 May;37(5):1535-1545. doi: 10.1007/s00381-021-05094-y. Epub 2021 Feb 28.
This study uses a large-population national database to describe the presenting clinical, sociodemographic, treatment, and clinical outcome differences between pediatric and adult craniopharyngiomas.
This study utilized the 2004-2015 National Cancer Database and was queried for all cases of craniopharyngioma. Multivariate Cox proportional-hazards analysis was used to determine clinical and sociodemographic factors associated with mortality. Kaplan-Meier log-rank test determined differences in overall survival (OS) time.
The cohort consisted of 3638 patients, with 816 (22.4%) pediatric (≤ 18 years) patients. Pediatric patients presented with significantly higher frequency of large tumors (> 3 cm, 54.1 vs. 31.8%, p < 0.001), lower frequency of papillary subtype (0.9 vs. 11.5%, p < 0.001), and were exclusively treated at academic centers (100 vs. 73.4%, p < 0.001). Pediatric patients had significantly higher rates of adjuvant radiation (34.3 vs. 22.3%; p < 0.001), and had significantly lower 90-day mortality (1.6 vs. 4.9%; p < 0.001); however, no significant differences in extent of resection (p = 0.93), length of hospital stay (p = 0.53), and 30-day readmissions (p = 0.06) were observed between pediatric and adult patients. On Kaplan-Meier log-rank test, there were no significant differences in OS in pediatric patients receiving gross total resection (GTR), subtotal resection (STR), or STR + adjuvant radiation (p = 0.68). Lastly, when comparing endoscopic and open surgical approaches in pediatric patients, there were no significant differences in extent of surgical resection (p = 0.81), length of hospital stay (p = 0.54), 30-day readmissions (p = 0.22), and 90-day mortality (p = 0.80).
Craniopharyngioma has improved OS in pediatric compared to adult patients. Pediatric craniopharyngioma patients are best managed within multidisciplinary teams at academic centers with an individualized approach.
本研究利用大型人群国家数据库描述儿科和成人颅咽管瘤之间的临床表现、社会人口统计学、治疗和临床结局差异。
本研究利用 2004 年至 2015 年国家癌症数据库，对所有颅咽管瘤病例进行了查询。多变量 Cox 比例风险分析用于确定与死亡率相关的临床和社会人口统计学因素。Kaplan-Meier 对数秩检验确定总生存（OS）时间的差异。
该队列包括 3638 例患者，其中 816 例（22.4%）为儿科（≤18 岁）患者。儿科患者肿瘤明显更大（>3cm，54.1% vs. 31.8%，p<0.001），乳头状亚型比例较低（0.9% vs. 11.5%，p<0.001），仅在学术中心治疗（100% vs. 73.4%，p<0.001）。儿科患者辅助放疗率显著升高（34.3% vs. 22.3%；p<0.001），90 天死亡率显著降低（1.6% vs. 4.9%；p<0.001）；然而，在肿瘤切除程度（p=0.93）、住院时间（p=0.53）和 30 天再入院率（p=0.06）方面，儿科患者与成人患者之间无显著差异。在 Kaplan-Meier 对数秩检验中，接受大体全切除（GTR）、次全切除（STR）或 STR+辅助放疗的儿科患者在 OS 方面无显著差异（p=0.68）。最后，比较儿科患者内镜和开放式手术方法时，手术切除程度（p=0.81）、住院时间（p=0.54）、30 天再入院率（p=0.22）和 90 天死亡率（p=0.80）无显著差异。
与成人患者相比，颅咽管瘤在儿科患者中的 OS 有所改善。儿科颅咽管瘤患者最好在多学科团队的指导下，在学术中心接受个体化治疗。
