儿童髓母细胞瘤的临床预后及危险因素分析

Analysis of clinical prognosis and risk factors for children with medulloblastoma

目的探讨髓母细胞瘤患者的临床预后及危险因素。方法回顾性分析2003年1月至2007年1月首都医科大学附属北京天坛医院神经外科收治的92例儿童髓母细胞瘤患者的临床资料，对患者的肿瘤切除程度、影像学资料、病理类型、放疗、是否化疗、临床预后等进行了调查和总结。采用Kaplan-Meier单因素分析和多因素Cox回归分析，对各种影响因素进行统计学分析。结果92例儿童髓母细胞瘤患者中男65例，女27例；年龄3～17岁。随访时间为6—127个月，中位随访时间为84．0个月。其中经典型髓母细胞瘤60例，促纤维增生／结节型24例，大细胞型1例，问变型7例。19例术前发现肿瘤播散，12例术后残余肿瘤≥1．5cm2，6例同时合并以上两种情况。81例肿瘤位于后颅窝中线，其中53例肿瘤浸润第四脑室底部；11例肿瘤位于一侧小脑半球或小脑脑桥角。多因素Cox回归分析显示大细胞／间变型、肿瘤播散是影响患者预后的独立危险因素（P〈0．001）。结论大细胞／间变型、肿瘤播散是影响患者预后的独立危险因素，其预后较差，需要给予不同的治疗方案。

Objective To investigate prognosis and risk factors for children with medulloblastoma. Methods The clinical data of 92 children with medulloblastoma admitted to the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University fi＇om January 2003 to January 2007 were analyzed retrospectively. The tumor resection degree, imaging data, pathological type, radiotherapy, chemotherapy or not, and clinical prognosis of the children were investigated and summarized. Kaplan-Meier single factor analysis and Cox multivariate regression analysis were used to conduct statistical analysis for various influencing factors. Results Of the 92 children with medulloblastoma, 27 were females and 65 were males. Their age ranged from 3 to 17. The follow-up time ranged from 6 to127 months （ median follow- up time 84. 0 months）. Sixty children had classic medulloblastorna, 24 were desmoplastic type, 1 was large cell type, and 7 were anaplastic type. Nineteen children had tumor spread before procedure, 12 had postoperative residual tumor 〉 1.5 cm2, and 6 had both of them. The tumors of 81 children were located in the posterior fossa midline, 53 of them infiltrated the base of the fourth ventricle, and 11 were located in one side of the cerebellar hemisphere or cerebellopontine angle. Regression analysis showed that the large cell/ anaplastie histological type and tumor spread were the independent risk factors for affecting the prognosis of the children （P 〈 0. 001 ）. Conclusions The large cell/anaplastic histological type and tumor spread are the independent risk factors for affecting the prognosis of the children. The prognosis of the children is poor and needs to be treated with different treatment options.