Tahta Alican, Akalan Nejat
Istanbul Medipol University, School of Medicine, Department of Neurosurgery, TEM Goztepe exit, Bagcila, Istanbul, Turkey.
Childs Nerv Syst. 2023 Feb;39(2):369-377. doi: 10.1007/s00381-022-05822-y. Epub 2023 Jan 6.
Primary intracranial tumors are rare tumors in infants. They differ from those found in other pediatric age groups in terms of clinical presentation, histopathological diagnosis, adjuvant therapies, and outcome. Ki-67 index has also shown promising results as a prognostic factor in different types of intracranial tumors in children and adults. However, the importance and the best cutoff point of Ki-67 index in primary intracranial tumors of infants remains unclear. We aimed to analyze prognostic value of Ki-67 index in primary intracranial tumors of infants.
This study retrospectively reviewed the records of 28 infants undergoing surgical resection for primary intracranial tumors between April 2016 and March 2021. We analyzed clinical characteristics, tumor location, extent of resection, histopathological diagnosis, Ki-67 index, and overall survival (OS). To define the most relevant cutoff value for Ki-67 index, "Cutoff Finder" was used.
The median age at diagnosis was 188 days for all patients. Fifteen of the patients were boys and 13 were girls. Tumors were located supratentorial in 13 patients and infratentorial in 15 patients. Gross total resection was performed in 7 of 13 supratentorial tumors and 9 of 15 infratentorial tumors. The mean Ki-67 index of the supratentorial tumors was 49.6%, the median was 55%; for infratentorial tumors, the mean was 49.9%, and the median was 70%. Tumor grade (p = 0.019) and Ki-67 index (p = 0.003) were found as significant predictors of OS in log-rank testing for Kaplan-Meier survival analysis. Univariate cox regression analysis identified high Ki-67 index as prognostic factor for worse OS, with hazard ratio of 8.852 (95% CI 1.95-64.80; p = 0.0108). High Ki-67 index was found as independent prognostic factor for worse OS in multivariate cox regression analysis (HR 7.036; 95% CI 1.229-65.82; p = 0.0457).
High-grade and high Ki-67 index were associated with worse outcome. Ki-67 index did show a distinct prognostic value for OS within our cohort at a cutoff value of 72.5%.
原发性颅内肿瘤在婴儿中是罕见肿瘤。它们在临床表现、组织病理学诊断、辅助治疗及预后方面与其他儿童年龄组中发现的肿瘤有所不同。Ki-67指数作为儿童和成人不同类型颅内肿瘤的预后因素也显示出有前景的结果。然而，Ki-67指数在婴儿原发性颅内肿瘤中的重要性及最佳临界值仍不清楚。我们旨在分析Ki-67指数在婴儿原发性颅内肿瘤中的预后价值。
本研究回顾性分析了2016年4月至2021年3月期间28例接受原发性颅内肿瘤手术切除的婴儿的记录。我们分析了临床特征、肿瘤位置、切除范围、组织病理学诊断、Ki-67指数及总生存期（OS）。为确定Ki-67指数最相关的临界值，使用了“临界值查找器”。
所有患者诊断时的中位年龄为188天。其中15例为男孩，13例为女孩。13例患者肿瘤位于幕上，15例位于幕下。13例幕上肿瘤中的7例及15例幕下肿瘤中的9例进行了全切除。幕上肿瘤的平均Ki-67指数为49.6%，中位数为55%；幕下肿瘤的平均指数为49.9%，中位数为70%。在Kaplan-Meier生存分析的对数秩检验中，肿瘤分级（p = 0.019）和Ki-67指数（p = 0.003）被发现是OS的显著预测因素。单因素Cox回归分析确定高Ki-67指数是OS较差的预后因素，风险比为8.852（95%CI 1.95 - 64.80；p = 0.0108）。在多因素Cox回归分析中，高Ki-67指数被发现是OS较差的独立预后因素（HR 7.036；95%CI 1.229 - 65.82；p = 0.0457）。
高级别及高Ki-67指数与较差的预后相关。在我们的队列中，Ki-67指数在临界值为72.5%时确实对OS显示出明显的预后价值。
