83例颅内室管膜肿瘤临床分析

Intracranial ependymal tumour： a clinical study of 83 cases

目的总结颅内室管膜肿瘤的临床特点，探讨其预后相关因素。方法回顾性总结83例颅内室管膜肿瘤的分布、年龄、病理及影像学特点，分析其手术治疗及辅助治疗的效果。结果83例颅内室管膜肿瘤中幕下室管膜肿瘤41例，幕上室管膜肿瘤42例。年龄≤15岁37例，〉15岁46例。病理按WHO肿瘤组织学分级：Ⅰ～Ⅱ级58例（69．9％），Ⅲ级25例（30．1％）。手术全切67例（80．7％），次全切16例（19．3％）。5年存活率81．9％（68／83）。手术切除程度和病理分级是影响颅内室管膜肿瘤患者预后的高危因素。结论肿瘤全切可明显改善患者的预后。术后发现肿瘤残留，适合者可考虑二次手术切除。间变性室管膜瘤预后较差。放疗在颅内室管膜肿瘤的治疗中具有重要作用，化疗作用有限，主要尝试用于婴幼儿以避免放疗的副损害。

Objective To study the clinical features of patients with intracranial ependymal turnout, and explore the prognostic factors which have a significant association with the outcome. Methods Eighty-three patients with histologically proven ependymal tumour were retrospectively reviewed. The tumour location, the patients＇ age, the histological features, imaging characteristics, surgical management and adjuvant therapy were studied. Results In 83 cases of intracranial ependymal tumour,41 cases were infratentorial and 42 cases were supratentorial ependymal tumour, 37 patients age ≤15 years, while 46 patients age 〉 15 years. Fifty-eight patients （69.9%） and 25 patients（30.1%） had low （WHO Ⅰ - Ⅱ ） andhigh-grade （WHO Ⅲ ） tumors respectively. Sixty-seven （80.7%） patients had gross total resection and 16 patients （ 19.3% ） had subtotal resection. The 5-year survival rate was 81.9% （ 68/83 ）. The factors that were found to have a statistical significance association with the outcome were the extent of the resection and the pathologic characteristics. Conclusions Gross total resection of these tumors results in a good long-term outcome. Reoperation should be considered, if feasible, to remove residual malignant tissue. Anaplastic ependymomas carries a much poorer prognosis. Radiotherapy may play an important role in their treatment. The role of chemotherapy appears limited but can be attempted, especially in the very young, in order to avoid the deleterious effect of radiotherapy.