Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom.
World Neurosurg. 2024 Apr;184:e266-e273. doi: 10.1016/j.wneu.2024.01.107. Epub 2024 Jan 28.
Tectal plate gliomas (TPGs) are a heterogeneous group of uncommon brain tumors. TPGs are considered indolent and are usually managed conservatively but they have the potential to transform into higher-grade tumors. The aims of this study were to investigate the natural history of adult TPG, treatment outcomes, and overall survival.
A retrospective cohort analysis was performed of adult patients with TPG between 1993 and 2021. Baseline clinical, radiologic, and management characteristics were collected. The primary outcome was tumor progression, defined as increasing size on radiologic assessment or new gadolinium contrast enhancement. Secondary outcomes included management and mortality.
Thirty-nine patients were included, of whom 23 (52.2%) were men. Median age at diagnosis was 35 years (interquartile range, 27-53). Radiologic tumor progression was observed in 8 patients (20.5%). The 10-year progression-free survival was 72.6% (95% confidence interval [CI], 0.58-0.91). The 10-year overall survival was 86.5% (95% confidence interval, 0.75-1.0). Cerebrospinal fluid diversion procedures were used in 62% of the cohort (n = 24). Seventeen patients (43.6%) underwent at least 1 endoscopic third ventriculostomy, whereas only 6 patients (15.4%) underwent at least 1 ventriculoperitoneal shunt.
TPG has an overall favorable clinical prognosis, although progression occurs in 1 in 5 patients. Showing accurate factors by which patients with TPG may be risk stratified should be a key area of further research. A follow-up duration of 10 years would be a reasonable window based on the radiologic progression rates in this study; however, larger cohort studies are needed to answer both questions definitively.
顶盖层胶质瘤（TPG）是一组罕见的脑肿瘤，具有异质性。TPG 被认为是惰性的，通常采用保守治疗，但它们有转化为高级别肿瘤的潜力。本研究的目的是探讨成人 TPG 的自然史、治疗结果和总生存率。
对 1993 年至 2021 年期间的成人 TPG 患者进行回顾性队列分析。收集基线临床、影像学和管理特征。主要结局是肿瘤进展，定义为影像学评估时肿瘤增大或新出现钆增强。次要结局包括治疗和死亡率。
共纳入 39 例患者，其中 23 例（52.2%）为男性。诊断时的中位年龄为 35 岁（四分位距 27-53）。8 例（20.5%）患者出现影像学肿瘤进展。10 年无进展生存率为 72.6%（95%置信区间，0.58-0.91）。10 年总生存率为 86.5%（95%置信区间，0.75-1.0）。62%的患者（n=24）接受了脑脊液引流术。17 例（43.6%）患者至少行 1 次内镜第三脑室造瘘术，而仅 6 例（15.4%）患者至少行 1 次脑室-腹腔分流术。
TPG 的总体临床预后良好，尽管 1/5 的患者会出现进展。准确识别可能使 TPG 患者具有风险分层的因素应成为进一步研究的重点领域。根据本研究的影像学进展率，10 年的随访时间可能是一个合理的窗口；然而，需要更大的队列研究来明确这两个问题。
