Ryoo James S, Khalid Syed I, Chaker Anisse N, Behbahani Mandana, Nunna Ravi S, Mehta Ankit I
Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL.
Department of Surgery, Rush University Medical Center, Chicago, IL.
Neurooncol Pract. 2020 Sep 28;8(1):98-105. doi: 10.1093/nop/npaa060. eCollection 2021 Feb.
SEGA is a rare, slow-growing CNS neoplasm that has historically been treated by surgical resection. However, the advent of a mammalian target of rapamycin complex-1 inhibitor, everolimus, has shown promising results in recent clinical trials. We sought to provide an analysis of epidemiological and survival risk factors in this rare tumor entity, while comparing trends in surgical management before and after introduction of everolimus in SEGAs.
Patients with SEGA were queried from the National Cancer Database between 2004 and 2015. Standard statistical analysis was conducted to assess variables associated with the odds of performing surgery and survival, while controlling for confounding variables.
A total of 460 patients were diagnosed with SEGA. Multivariable analysis of survival demonstrated that increased age was associated with decreased survival (HR, 1.05; < .0001). Multivariable analysis of surgery showed increased age (odds ratio [OR], 1.02, = .04) and tumor size 20 mm or larger (OR, 9.52-16.75, < .0001 for all) to be associated with higher odds of performing surgery. The use of radiotherapy (OR, 0.12, = .008) or chemotherapy (OR, 0.21, = .008) was associated with lower odds of surgery. A comparison of surgical rates between 2004 and 2010 and 2011 and 2015 was found to be significantly different, with a lower rate of surgery seen after 2011 (60.63% vs 48.06%, = .007).
Our analysis of SEGAs demonstrated that age was the only variable affecting overall survival. Surgical resection was performed in older patients with larger tumors (> 20 mm) as a primary mode of treatment, without chemoradiotherapy. Expectedly, rates of surgical resection were found to have decreased since 2011, after FDA approval of everolimus for SEGA treatment.
室管膜下巨细胞星形细胞瘤（SEGA）是一种罕见的、生长缓慢的中枢神经系统肿瘤，传统上通过手术切除进行治疗。然而，雷帕霉素复合物1抑制剂依维莫司的出现，在最近的临床试验中显示出了有前景的结果。我们试图对这种罕见肿瘤实体的流行病学和生存风险因素进行分析，同时比较依维莫司引入SEGA前后手术治疗的趋势。
在2004年至201年期间，从国家癌症数据库中查询SEGA患者。进行标准统计分析，以评估与手术几率和生存相关的变量，同时控制混杂变量。
共有460例患者被诊断为SEGA。生存的多变量分析表明，年龄增加与生存率降低相关（风险比[HR]为1.05；P<0.0001）。手术的多变量分析显示，年龄增加（优势比[OR]为1.02，P=0.04）和肿瘤大小20毫米或更大（OR为9.52至16.75，所有P<0.0001）与手术几率较高相关。使用放疗（OR为0.12，P=0.008）或化疗（OR为0.21，P=0.008）与手术几率较低相关。发现2004年至2010年与2011年至2015年之间的手术率存在显著差异，2011年之后手术率较低（60.63%对48.06%，P=0.007）。
我们对SEGA的分析表明，年龄是影响总生存的唯一变量。手术切除是年龄较大、肿瘤较大（>20毫米）患者的主要治疗方式，不进行放化疗。不出所料，自2011年美国食品药品监督管理局批准依维莫司用于SEGA治疗后，手术切除率有所下降。
