手术治疗儿童第四脑室室管膜瘤的预后分析  

Prognostic analysis of surgical treatment for fourth ventricle ependymomas in children

作　　者：王冠一 贾怡斌 叶玉勤 苏鑫洪 汪仁聪 胡学安 贺晓生 Wang Guanyi;Jia Yibin;Ye Yuqin;Su Xinhong;Wang Rencong;Hu Xuean;He Xiaosheng(Department of Neurosurgery,Xijing Hospital,Air Force Military Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学西京医院神经外科,西安710032

出　　处：《中华神经外科杂志》2020年第9期886-890,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81971156)。

摘　　要：目的探讨手术治疗儿童第四脑室室管膜瘤的预后情况。方法回顾性分析2008年1月至2019年10月空军军医大学西京医院神经外科采用手术治疗的17例儿童第四脑室室管膜瘤患者的临床资料。男/女=11/6。中位诊断年龄为5(1~16)岁,其中>3岁者11例(≤5岁9例),≤3岁者6例。>3岁者术后根据个体情况予以相应的放化疗。所有患儿均行随访,采用Kaplan-Meier法分析患者的生存情况。结果 17例患儿,肿瘤全切除11例,次全切除6例。术后病理学显示世界卫生组织(WHO )病理学分级Ⅱ级者8例,Ⅲ级(间变性)者9例。中位随访时间为16(1~96)个月,至末次随访,死亡10例;存活7例,其中复发3例。Kaplan-Meier分析结果显示,17例患儿的1年总生存率为58.8%,2年为43.4%,中位生存时间为18.0个月。Log-rank检验结果显示,不同性别、年龄、肿瘤切除程度、肿瘤WHO分级患者的生存时间差异均无统计学意义(均P>0.05);Ki-67指数<20%者的生存概率高于≥20%者(P=0.030)。结论儿童第四脑室室管膜瘤术后预后较差,Ki-67指数可能是影响患儿生存的重要因素,其他因素有待增加样本量进一步研究。Objective To investigate the prognosis of surgical treatment for fourth ventricle ependymomas in children.Methods The clinical data of 17 children with fourth ventricle ependymomas who underwent surgical treatment at Department of Neurosurgery,Xijing Hospital,Air Force Military Medical University from January 2008 to October 2019 were retrospectively reviewed.The male/female ratio was 11/6.The median diagnostic age was 5(1-16)years old.There were 11 cases of>3 years old,9 cases of≤5 years old and 6 cases of≤3 years old.The patients older than 3 years underwent radiotherapy and chemotherapy according to the individual conditions.All the children underwent clinical follow-up.Kaplan-Meier method was used to analyze the survival of patients.Results Of all 17 patients,total resection was achieved in 11 cases and subtotal resection in 6 cases.Postoperative pathological examination of all patients showed that there were 8 cases of WHO gradeⅡependymoma,and 9 cases of WHO gradeⅢ(anaplastic)ependymoma.The median follow-up time was 16(1-96)months.By the last follow-up,10 patients died,7 survived and 3 relapsed.The Kaplan Meier analysis showed that the 1-year overall survival rate of 17 patients was 58.8%,2-year survival rate was 43.4%,and the median survival time was 18.0 months.There was no significant difference in survival time according to sex,age,tumor resection degree and WHO classification(all P>0.05).The survival probability of patients with Ki-67 index<20%was higher than that of patients with Ki-67 index≥20%(P=0.030).Conclusions The prognosis of children with fourth ventricle ependymomas seems poor.The Ki-67 index may be an important factor affecting the survival of children and other factors need to be further studied in a larger cohort.

关 键 词：室管膜瘤 第四脑室 儿童 神经外科手术 预后 

分 类 号：R739.41[医药卫生—肿瘤]