Schild S E, Scheithauer B W, Haddock M G, Wong W W, Lyons M K, Marks L B, Norman M G, Burger P C
Department of Radiation Oncology, Mayo Clinic Scottsdale, Arizona 85259, USA.
Cancer. 1996 Dec 15;78(12):2564-71. doi: 10.1002/(sici)1097-0142(19961215)78:12<2564::aid-cncr16>3.0.co;2-u.
This study examined the outcome of patients with histologically confirmed pineal region tumors.
One hundred thirty-five patients with histologically confirmed pineal tumors and other germ cell tumors of the brain were evaluated retrospectively. The pineal parenchymal tumors (PPTs) included 15 pineoblastomas (PB), 2 mixed PPTs, 4 PPTs with intermediate differentiation, and 9 pineocytomas. The germ cell tumors included 48 germinomas, 26 mixed germ cell tumors, 11 mature teratomas, 9 immature teratomas, 6 malignant teratomas, 2 yolk sac tumors, and 3 choriocarcinomas. Patients were treated with various combinations of chemotherapy, radiotherapy, and surgery. The duration of follow-up ranged from 0.25 to 37.3 years, with a median follow-up of 5.3 years.
The 5-year patient survival rate was 86% for those with mature teratomas; 86% with pineocytomas; 80% with germinomas; 67% with immature teratomas; 49% with PPTs, excluding pineocytomas; 38% with mixed germ cell tumors; and 17% with other germ cell histologies (P = 0.0001). The delivery of > 44 Gray (Gy) to germinomas and > 50 Gy to PPTs and nongerminomatous germ cell tumors (NGGCTs) other than mature and immature teratomas was associated with improved survival. A greater extent of resection was associated with a higher rate of survival in all patients with NGGCTs. The administration of chemotherapy was associated with improved survival in those patients with NGGCTs other than mature and immature teratomas.
Prognosis was dependent on tumor type. Obtaining a tissue diagnosis made it possible to tailor therapy according to tumor type and potentially improve the survival of patients. Survival was dependent on the dose of radiation administered to patients with PPTs, germinomas, and NGGCTs other than mature and immature teratomas. More extensive resection and the use of chemotherapy were also associated with improved survival in subgroups of patients with NGGCTs. Treatment recommendations are described in detail in the article.
本研究调查了组织学确诊的松果体区肿瘤患者的预后情况。
对135例组织学确诊的松果体肿瘤及其他脑生殖细胞肿瘤患者进行回顾性评估。松果体实质肿瘤（PPTs）包括15例松果体母细胞瘤（PB）、2例混合性PPTs、4例中间分化的PPTs和9例松果体细胞瘤。生殖细胞肿瘤包括48例生殖细胞瘤、26例混合性生殖细胞肿瘤、11例成熟畸胎瘤、9例未成熟畸胎瘤、6例恶性畸胎瘤、2例卵黄囊瘤和3例绒毛膜癌。患者接受了化疗、放疗和手术的各种联合治疗。随访时间为0.25至37.3年，中位随访时间为5.3年。
成熟畸胎瘤患者的5年生存率为86%；松果体细胞瘤患者为86%；生殖细胞瘤患者为80%；未成熟畸胎瘤患者为67%；排除松果体细胞瘤的PPTs患者为49%；混合性生殖细胞肿瘤患者为38%；其他生殖细胞组织学类型患者为17%（P = 0.0001）。生殖细胞瘤放疗剂量>44格雷（Gy）、PPTs及除成熟和未成熟畸胎瘤外的非生殖细胞瘤性生殖细胞肿瘤（NGGCTs）放疗剂量>50 Gy与生存率提高相关。切除范围更大与所有NGGCTs患者的生存率更高相关。化疗与除成熟和未成熟畸胎瘤外的NGGCTs患者生存率提高相关。
预后取决于肿瘤类型。获得组织诊断能够根据肿瘤类型制定个体化治疗方案，并可能提高患者生存率。生存率取决于给予PPTs、生殖细胞瘤和除成熟和未成熟畸胎瘤外的NGGCTs患者的放疗剂量。更广泛的切除及化疗的应用也与NGGCTs患者亚组的生存率提高相关。本文详细描述了治疗建议。
