脑室内少突胶质细胞瘤和中枢神经细胞瘤的对比研究

A comparative study of intraventricular oligodendroglioma and central neurocytoma

目的比较脑室内少突胶质细胞瘤（IVO）和中枢神经细胞瘤（cN）的临床特征、治疗方法以及预后，旨在提高临床医生对两者的认识。方法回顾性分析2011年1月至2015年12月南方医科大学南方医院神经外科收治的8例IVO患者和12例CN患者的临床资料。8例IVO患者均行手术治疗，术后3例行放射治疗或化疗。9例CN患者行手术治疗，术后7例行放射治疗；其余3例CN患者仅行放射治疗。比较IVO和CN的临床特征，采用Kaplan—Meier法进行预后分析。随访时间为3d至58个月。结果IVO和CN均好发于青年人，临床上均以梗阻性脑积水所致的颅内压增高为主要表现。影像学上，两者在发病部位（P=0．007）、“扇贝征”（P=0．020）、流空血管影（P=0．020）以及脑室壁侵犯（P=0．001）方面的差异均有统计学意义。病理学方面，两者在核分裂象（P=0．008），脑实质浸润（P=0．018），免疫组化指标Olig2（P〈0．001）、Syn（P=0．018）以及NeuN（P〈0．001）表达上的差异均有统计学意义；IVO患者的MIB-1标记指数高于CN患者（P=0．035）。IVO患者的病死率明显高于CN患者（分别为38％和0％，P=0．021），而累积生存率则明显低于CN患者（分别为60％和100％，P=0．028）。结论IVO和CN有相似的发病年龄和临床表现，但两者有其各自的影像学表现和病理学特征。治疗上IVO和CN均以手术切除为主。CN患者的预后好于IVO患者。

Objective To compare the clinical features, therapies and prognosis between intraventricular oligodendroglioma （IVO） and central neurocytoma （CN） so as to raise awareness of these tumors. Methods This retrospective analysis included 8 cases of IVO and 12 cases of CN admitted to Department of Neurosurgery, Nanfang Hospital, Southern Medical University from January 2011 to December 2015. The clinical data included general information, clinical manifestations, imaging characteristics, pathological findings, treatments and outcomes. Eight cases of IVO underwent resection. 3 cases of IVO received postoperative radiotherapy or chemotherapy. Nine eases of CN underwent resection and among them 7 cases received radiotherapy. The remaining 3 cases of CN received radiotherapy only. Differences in clinical characteristics between IVO and CN were analyzed using independent-samples t test, X2 test, Fisher~ exact test or rank-sum test. Differences in prognosis between IVO and CN were analyzed using the Kaplan- Meier product-limit method. The follow-up time ranged from 3 days to 58 months. Results Both IVO and CN occurred most commonly in young adults and presented with features of raised intracranial pressure secondary to obstructive hydrocephalus. However, in terms of radiological appearances, they were quite different in location （ P = 0. 007 ） , ＂scalloping＂ appearance （ P = 0. 020） , vessels void signal （ P = 0.020） and ventricular wall invasion （P = 0. 001 ）. Pathologically, they showed obvious differences in mitotic count （P =0. 008）, infiltration of parenchyma （P =0. 018） and the expression of Olig2 （P 〈0. 001 ）, Syn （P = 0.018） and NeuN （ P 〈 0. 001 ）. In addition, MIB-1 labeling index （ P = 0. 035 ） and case fatality rate （38% vs. 0%, P =0.021） of IVO were much higher than those of CN, while cumulative survival rate of IVO was much lower than that of CN （60% vs. 100%, P = 0. 028）. Conclusions IVO and CN are similar in onset age and clinical presentations but different in imaging manifestations and pathological features. Surgery is the main treatment modality of these tumors. The prognosis of CN seems better than IVO.