Yengo-Kahn Aaron M, Wellons John C, Jensen Hailey, Kulkarni Abhaya V, Chu Jason K, Hauptman Jason S, Isaacs Albert M, Jackson Eric M, McDonald Patrick J, McDowell Michael M, Pollack Ian F, Reeder Ron, Riva-Cambrin Jay, Rocque Brandon G, Strahle Jennifer M, Tamber Mandeep S, Kestle John R W
1Department of Neurosurgery, University of Utah, Salt Lake City, Utah.
2Division of Neurosurgery, Children's Hospital of Orange County, Orange, California.
J Neurosurg Pediatr. 2025 Feb 7;35(4):327-337. doi: 10.3171/2024.10.PEDS24454. Print 2025 Apr 1.
Conditional survival incorporates the effect of time passed since an event to current data in an easy-to-understand, relevant format. Data from the Hydrocephalus Clinical Research Network (HCRN) registry were analyzed with conditional survival to improve patient and family counseling after hydrocephalus treatment.
Children with hydrocephalus who underwent first-time treatment by a single proximal catheter ventriculoperitoneal shunt (VPS) or endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization with at least 3 years of follow-up in the prospective HCRN registry (14 sites, April 24, 2008-December 31, 2020) were included. Those with nonperitoneal or multiple proximal catheters were excluded. The probability of failure-free survival at 3, 5, and 10 years was calculated as a function of time since surgery.
Overall, 5782 patients were included (1609 with ETV, 4173 with VPS placement). The median time to censoring was 5.3 years. The overall respective 3-, 5-, and 10-year failure-free survival rates were 59%, 58%, and 57%, respectively, for ETV and 62%, 58%, and 54%, respectively, for VPS. If VPS failure had not occurred by 1 year postoperatively, the 3-, 5-, and 10-year failure-free survival rates were 85%, 79%, and 66%, respectively. If ETV failure had not occurred by 1 year, the 3-, 5-, and 10-year failure-free survival rates were 93%, 91%, and 86%, respectively. Conditional survival also varied by age and etiology.
Patients who do not require revision surgery in the 1st year have an excellent chance of being revision free for an extended period. Conditional survival plots provided are intuitive and can be used in the counseling of North American patients with surgically treated hydrocephalus.
条件生存以一种易于理解且相关的形式纳入了自事件发生以来到当前数据所经过时间的影响。对脑积水临床研究网络（HCRN）登记处的数据进行条件生存分析，以改善脑积水治疗后的患者及家属咨询。
纳入前瞻性HCRN登记处（14个地点，2008年4月24日至2020年12月31日）中接受单次近端导管脑室腹腔分流术（VPS）或内镜下第三脑室造瘘术（ETV）首次治疗且有或无脉络丛烧灼术并至少随访3年的脑积水儿童。排除那些采用非腹膜或多个近端导管的患者。计算自手术以来不同时间点3年、5年和10年无失败生存的概率。
总共纳入5782例患者（1609例行ETV，4173例行VPS植入）。删失的中位时间为5.3年。ETV的3年、5年和10年总体无失败生存率分别为59%、58%和57%，VPS的分别为62%、58%和54%。如果术后1年内未发生VPS失败，3年、5年和10年无失败生存率分别为85%、79%和66%。如果术后1年内未发生ETV失败，3年、5年和10年无失败生存率分别为93%、91%和86%。条件生存也因年龄和病因而异。
第一年不需要翻修手术的患者有很大机会在较长时间内无需翻修。所提供的条件生存曲线直观，可用于为接受手术治疗的北美脑积水患者提供咨询。
