Bouffet E, Pierre-Kahn A, Marchal J C, Jouvet A, Kalifa C, Choux M, Dhellemmes P, Guérin J, Tremoulet M, Mottolese C
Department of Pediatric Oncology, Centre Léon Bérard, Lyon, France.
Cancer. 1998 Dec 1;83(11):2391-9. doi: 10.1002/(sici)1097-0142(19981201)83:11<2391::aid-cncr20>3.0.co;2-0.
Factors that could optimize the management of pediatric spinal cord astrocytoma remain unclear and controversial.
To determine the factors that influence the prognosis of pediatric patients with spinal cord astrocytomas, a series of 73 consecutive patients at 13 French treatment centers with histologically proven spinal cord astrocytomas was retrospectively reviewed. Hospital records, operative records, and results of radiologic investigations were available in all cases. Follow-up was achieved in 94% of cases.
Seventy percent of the patients had low grade (1 or 2) tumors. Total or subtotal surgical resection was achieved in 43%. Thirty-six patients were irradiated following surgery. Fifty-one patients were alive at a median follow-up of 54 months. Twenty-three patients relapsed. Univariate analysis showed that good outcome was correlated with male gender, age younger than 7 years, duration of presenting symptoms longer than 2 months, the presence of spinal deformities, and low grade histology, whereas sensory loss was associated with decreased survival. Multivariate analysis using the Cox proportional hazards model confirmed that histology (relative risk [RR] = 7.69) and the interval between first symptoms and diagnosis (RR = 4.93) were significant independent prognostic factors. The extent of surgery or radiotherapy had no clear influence on survival.
This review sheds light on the prognoses of pediatric patients with spinal cord astrocytomas and may help to determine therapeutic strategies based on patients' clinical, radiologic, and pathologic features.
能够优化小儿脊髓星形细胞瘤治疗管理的因素仍不明确且存在争议。
为确定影响小儿脊髓星形细胞瘤患者预后的因素，对法国13个治疗中心连续收治的73例经组织学证实的脊髓星形细胞瘤患儿进行了回顾性研究。所有病例均有医院记录、手术记录及影像学检查结果。94%的病例获得了随访。
70%的患者为低级别（1级或2级）肿瘤。43%的患者实现了全切或次全切手术。36例患者术后接受了放疗。中位随访54个月时，51例患者存活。23例患者复发。单因素分析显示，良好预后与男性、年龄小于7岁、首发症状持续时间超过2个月、存在脊柱畸形及低级别组织学相关，而感觉丧失与生存率降低有关。使用Cox比例风险模型进行的多因素分析证实，组织学（相对危险度[RR]=7.69）及首发症状与诊断之间的间隔时间（RR=4.93）是显著的独立预后因素。手术范围或放疗对生存率无明显影响。
本综述阐明了小儿脊髓星形细胞瘤患者的预后情况，并可能有助于根据患者的临床、影像学和病理特征确定治疗策略。
