Keeling Claire, Davies Simon, Goddard Jack, Ramaswamy Vijay, Schwalbe Edward C, Bailey Simon, Hicks Debbie, Clifford Steven C
Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom.
Neuro-oncology Section, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.
EClinicalMedicine. 2024 Feb 14;69:102469. doi: 10.1016/j.eclinm.2024.102469. eCollection 2024 Mar.
Medulloblastoma patients with a sub-total surgical resection (STR; >1.5 cm primary tumour residuum post-surgery) typically receive intensified treatment. However, the association of STR with poor outcomes has not been observed consistently, questioning the validity of STR as a high-risk disease feature.
We collected extent of resection (EOR) data from 1110 patients (from UK CCLG centres (n = 416, collected between September 1990 and July 2014) and published (n = 694) cohorts), the largest cohort of molecularly and clinically annotated tumours assembled to specifically assess the significance of EOR. We performed association and univariable/multivariable survival analyses, assessing overall survival (OS) cohort-wide and with reference to the four consensus medulloblastoma molecular groups and clinical features.
STR was reported in 20% (226/1110) of patients. Non-WNT (p = 0.047), children <5 years at diagnosis (p = 0.021) and metastatic patients (p < 0.0001) were significantly more likely to have a STR. In cohort-wide analysis, STR was associated with worse survival in univariable analysis (p < 0.0001). Examination of specific disease contexts showed that STR was prognostic in univariate analysis for patients receiving cranio-spinal irradiation (CSI) and chemotherapy (p = 0.016) and for patients with Group 3 tumours receiving CSI (p = 0.039). STR was not independently prognostic in multivariable analyses; outcomes for patients who have STR as their only risk-feature are as per standard-risk disease. Specifically, STR was not prognostic in non-metastatic patients that received upfront CSI.
In a cohort of 1100 molecularly characterised medulloblastoma patients, STR (n = 226) predicted significantly lower OS in univariable analysis, but was not an independent prognostic factor. Our data suggest that maximal resection can continue to be carried out for patients with medulloblastoma and suggest STR should not inform patient management when observed as a sole, isolated risk-feature.
Cancer Research UK, Newcastle Hospitals Charity, Children's Cancer North, British Division of the International Academy of Pathology.
接受次全手术切除（STR；术后残留原发性肿瘤>1.5厘米）的髓母细胞瘤患者通常会接受强化治疗。然而，STR与不良预后之间的关联并未一直得到观察，这对STR作为高危疾病特征的有效性提出了质疑。
我们收集了1110例患者的切除范围（EOR）数据（来自英国儿童癌症与白血病研究组（CCLG）中心的416例患者（收集时间为1990年9月至2014年7月）以及已发表的694例患者队列），这是为专门评估EOR的意义而汇集的最大的一组分子和临床注释肿瘤队列。我们进行了关联分析和单变量/多变量生存分析，在整个队列范围内以及参照四个共识性髓母细胞瘤分子组和临床特征评估总生存期（OS）。
20%（226/1110）的患者报告有STR。非WNT型（p = 0.047）、诊断时年龄<5岁的儿童（p = 0.021）和转移性患者（p < 0.0001）更有可能出现STR。在全队列分析中，在单变量分析中STR与较差的生存率相关（p < 0.0001）。对特定疾病背景的检查表明，对于接受颅脊髓照射（CSI）和化疗的患者（p = 0.016）以及对于接受CSI的3组肿瘤患者（p = 0.039），STR在单变量分析中具有预后意义。在多变量分析中STR不是独立的预后因素；以STR作为唯一风险特征的患者的预后与标准风险疾病相同。具体而言，在接受 upfront CSI的非转移性患者中，STR没有预后意义。
在一组1100例分子特征明确的髓母细胞瘤患者中，STR（n = 226）在单变量分析中预测总生存期显著降低，但不是独立的预后因素。我们的数据表明，对于髓母细胞瘤患者可以继续进行最大程度的切除，并且表明当STR作为唯一的、孤立的风险特征被观察到时，不应将其用于指导患者管理。
英国癌症研究中心、纽卡斯尔医院慈善机构、儿童癌症北方组织、国际病理学会英国分会。
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