Zhou Huan
Department of Neonatology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Transl Pediatr. 2023 Aug 30;12(8):1504-1516. doi: 10.21037/tp-23-362. Epub 2023 Aug 28.
Evidence on treatment modalities and survival in childhood primary brain and central nervous system (CNS) tumors remains contradictory, with previous studies often lacking sufficient patient cohort sizes to assess the differences in histological subtypes. This cohort study based on a large population investigated the effects of various treatments on the mortality of patients with different histological types of primary brain and CNS tumors from the Surveillance, Epidemiology, and End Results (SEER) database.
Data of demography, primary tumor site, histology, tumor grade and treatments from all pediatric patients with primary brain and CNS tumors were extracted in this retrospective cohort. The outcomes were overall, 1-, 5-, and 10-year all-cause mortality. Multivariate Cox proportional hazards models were to explore the associations of treatment with overall, 1-, 5-, and 10-year all-cause mortality, with hazard ratios (HRs) and 95% confidence intervals (CIs).
Totally 10,994 children were included, with the mean age at diagnosis of 7.3 years, and the median follow-up time of 5.0 years. Of which, 2,003 (18.2%) were diffuse astrocytoma, 3,188 (29.0%) were embryonal tumors, and 3,691 (33.5%) were malignant glioma. Then 4,333 (39.41%) children died during the follow-up. For diffuse astrocytomas and malignant gliomas, patients who received all other treatments were associated with overall, 1-, 5- and 10-year all-cause mortality compared to those only received resection. Embryonal tumors patients receiving resection with radiation only and those receiving resection with both chemotherapy and radiation were associated with lower odds of overall, 1-, 5- and 10-year all-cause mortality compared to patients who only received resection. For ependymal tumors, no surgery/only biopsy with chemotherapy, resection with chemotherapy only, resection with both chemotherapy and radiation, and other treatments had increased risks of overall all-cause mortality compared with resection. The risk of 1-year all-cause mortality increased in ependymal tumors with treatment involving resection and radiation. However, resection with both chemotherapy and radiation was not significantly associated with the 1- nor 5-year all-cause mortality.
Resection may be recommended for children with diffuse astrocytoma, ependymal tumors, and malignant glioma, while resection with radiotherapy or chemoradiation may be recommended for children with embryonal tumors.
关于儿童原发性脑和中枢神经系统（CNS）肿瘤的治疗方式和生存率的证据仍然相互矛盾，以往的研究往往缺乏足够大的患者队列规模来评估组织学亚型之间的差异。这项基于大量人群的队列研究，调查了各种治疗方法对来自监测、流行病学和最终结果（SEER）数据库中不同组织学类型的原发性脑和CNS肿瘤患者死亡率的影响。
在这项回顾性队列研究中，提取了所有患有原发性脑和CNS肿瘤的儿科患者的人口统计学、原发性肿瘤部位、组织学、肿瘤分级和治疗数据。结局指标为总体、1年、5年和10年全因死亡率。采用多变量Cox比例风险模型来探讨治疗与总体、1年、5年和10年全因死亡率之间的关联，并得出风险比（HRs）和95%置信区间（CIs）。
共纳入10994名儿童，诊断时的平均年龄为7.3岁，中位随访时间为5.0年。其中，2003例（18.2%）为弥漫性星形细胞瘤，3188例（29.0%）为胚胎性肿瘤，3691例（33.5%）为恶性胶质瘤。在随访期间，4333例（39.41%）儿童死亡。对于弥漫性星形细胞瘤和恶性胶质瘤，与仅接受手术切除的患者相比，接受所有其他治疗的患者在总体、1年、5年和10年全因死亡率方面存在关联。与仅接受手术切除的患者相比，接受单纯手术切除加放疗以及接受手术切除加化疗和放疗的胚胎性肿瘤患者，在总体、1年、5年和10年全因死亡率方面的几率较低。对于室管膜瘤，与手术切除相比，未手术/仅活检加化疗、单纯手术切除加化疗、手术切除加化疗和放疗以及其他治疗方法均增加了总体全因死亡率的风险。室管膜瘤在接受手术切除和放疗的治疗中，1年全因死亡率风险增加。然而，手术切除加化疗和放疗与1年及5年全因死亡率均无显著关联。
对于弥漫性星形细胞瘤、室管膜瘤和恶性胶质瘤患儿，可能建议进行手术切除；而对于胚胎性肿瘤患儿，可能建议手术切除加放疗或放化疗。
