Tandian David, Harlyjoy Alphadenti, Nugroho Setyo Widi, Ichwan Syaiful
Department of Neurosurgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Asian J Neurosurg. 2021 Sep 14;16(3):494-499. doi: 10.4103/ajns.AJNS_490_20. eCollection 2021 Jul-Sep.
The prognosis of medulloblastoma is better in patients who underwent complete treatment consisting of surgery, radiotherapy, and chemotherapy. However, the realization of such multidiscipline management is quite challenging in developing countries, including Indonesia. Until now, no study on the management of medulloblastoma has ever been conducted in Indonesia.
The authors aimed to study the characteristics, management, and mortality outcome of medulloblastoma patients in Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia.
This study was based on medical record and registry of 44 medulloblastoma patients who underwent tumor removal in Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia, between 2011 and 2018.
Cox regression analysis was utilized to determine the relationship between patients' demography, tumor characteristics, and treatment, with mortality.
The incidence of mortality was 84.1% and median months' survival time (95% confidence interval [CI]) was 13 (8.67-17.32). Gross total removal (GTR) was performed in 43.2% of all tumor removal surgery. Only 50% of all patients completed radiotherapy, and 6.8% concluded multimodalities treatment (surgery, radiotherapy, and chemotherapy). Significant statistical association between age, gender, and extent of resection with mortality was identified (HR [95% CI] for age: 0.44 [0.22-0.88], gender: 0.001 [0.000-0.27; REF: female], and biopsy: 31.52 [1.09-910.56; REF: GTR]).
The survival rate of medulloblastoma in Indonesia is inferior to that previously reported in other studies. There is no unusual characteristic contributing to neoteric risk factor. The authors surmise that insufficient multidisciplinary management for the disease, consisting of suboptimal tumor resection, the absence of risk stratification, and incomplete postsurgical treatment (radiotherapy and chemotherapy) resulted in such outcome.
接受过包括手术、放疗和化疗在内的完整治疗的髓母细胞瘤患者预后较好。然而，在包括印度尼西亚在内的发展中国家，实现这种多学科管理颇具挑战性。到目前为止，印度尼西亚尚未开展过关于髓母细胞瘤管理的研究。
作者旨在研究印度尼西亚雅加达西托·曼古库苏莫国家转诊医院髓母细胞瘤患者的特征、管理及死亡结局。
本研究基于2011年至2018年间在印度尼西亚雅加达西托·曼古库苏莫国家转诊医院接受肿瘤切除的44例髓母细胞瘤患者的病历和登记信息。
采用Cox回归分析来确定患者人口统计学特征、肿瘤特征及治疗与死亡率之间的关系。
死亡率为84.1%，中位生存月数（95%置信区间[CI]）为13（8.67 - 17.32）。所有肿瘤切除手术中43.2%进行了全切除（GTR）。所有患者中仅50%完成了放疗，6.8%完成了多模式治疗（手术、放疗和化疗）。确定年龄、性别及切除范围与死亡率之间存在显著的统计学关联（年龄的HR[95%CI]：0.44[0.22 - 0.88]，性别：0.001[0.000 - 0.27；参照：女性]，活检：31.52[1.09 - 910.56；参照：GTR]）。
印度尼西亚髓母细胞瘤的生存率低于其他研究先前报道的生存率。没有异常特征导致新的危险因素。作者推测，对该疾病的多学科管理不足，包括肿瘤切除不充分、缺乏风险分层以及术后治疗（放疗和化疗）不完整，导致了这样的结果。
