Wang Junhua, Wang Chuanwei, Huang Zhimin, Zhang Zhihua, Zhang Yuqi
Department of Neurosurgery, Tsinghua University Yuquan Hospital (Tsinghua University Hospital of Integrated Traditional Chinese and Western Medicine), Beijing, China.
School of Clinical Medicine, Tsinghua University, Beijing, China.
Front Pediatr. 2024 Dec 18;12:1441016. doi: 10.3389/fped.2024.1441016. eCollection 2024.
This study aims to summarize the characteristics of children under three years old (≤3 years) with central nervous system (CNS) tumors and to investigate the factors that influence their overall survival (OS) time.
We treated 171 pediatric patients (≤3 years) with CNS tumors at Yuquan Hospital of Tsinghua University from January 2016 to June 2023. Of these, 162 cases were successfully followed up. Kaplan-Meier survival analysis and Cox regression were utilized to evaluate factors potentially influencing OS of malignancies.
There was a male predominance among the patients. The three most common tumors were embryonal tumors, gliomas, and craniopharyngiomas. Gross total resection (GTR) was achieved in select cases. Patients with high-grade malignancies were advised to undergo chemotherapy and/or radiotherapy after surgery. Optic gliomas and diffuse midline gliomas were partially resected and treated with adjuvant treatments. The median survival time of low-grade malignant tumors was 41.5 months, while that of high-grade malignant tumors was 15 months. Kaplan-Meier survival analysis identified the factors potentially influencing OS of malignancies: extent of resection, CNS WHO grade, grade of malignancies, and Ki-67 labeling index (Ki-67 LI). Subsequent multivariate analysis highlighted the interactive factor (extent of resection × CNS WHO grade) along with Ki-67 LI, as the most significant variables. Factors such as sex, age, tumor location, and onset-to-treatment time appeared not to affect OS.
GTR remains the cornerstone of treatment for children (≤3 years) with CNS tumors, except for optic glioma, diffuse midline glioma, and germinoma. The interactive factor (extent of resection × CNS WHO grade) and Ki-67 LI are the most significant factors affecting OS. The implementation of preoperative neoadjuvant chemotherapy and early postoperative chemotherapy may enhance prognosis.
本研究旨在总结3岁及以下（≤3岁）中枢神经系统（CNS）肿瘤患儿的特征，并探讨影响其总生存（OS）时间的因素。
2016年1月至2023年6月，我们对清华大学玉泉医院收治的171例3岁及以下（≤3岁）CNS肿瘤患儿进行了治疗。其中，162例获得成功随访。采用Kaplan-Meier生存分析和Cox回归评估可能影响恶性肿瘤OS的因素。
患者中男性居多。三种最常见的肿瘤为胚胎性肿瘤、胶质瘤和颅咽管瘤。部分病例实现了全切除（GTR）。高级别恶性肿瘤患者术后建议接受化疗和/或放疗。视神经胶质瘤和弥漫性中线胶质瘤进行了部分切除并接受辅助治疗。低级别恶性肿瘤的中位生存时间为41.5个月，而高级别恶性肿瘤为15个月。Kaplan-Meier生存分析确定了可能影响恶性肿瘤OS的因素：切除范围、CNS世界卫生组织分级、恶性肿瘤分级和Ki-67标记指数（Ki-67 LI）。随后的多因素分析突出了交互因素（切除范围×CNS世界卫生组织分级）以及Ki-67 LI，作为最显著的变量。性别、年龄、肿瘤位置和发病至治疗时间等因素似乎不影响OS。
除视神经胶质瘤、弥漫性中线胶质瘤和生殖细胞瘤外，GTR仍然是3岁及以下（≤3岁）CNS肿瘤患儿治疗的基石。交互因素（切除范围×CNS世界卫生组织分级）和Ki-67 LI是影响OS的最显著因素。术前新辅助化疗和术后早期化疗的实施可能改善预后。
