不同QST分型儿童颅咽管瘤的临床特点及其在预后中的作用

Clinical value of QST classification in the treatment of children with craniopharyngioma

目的探讨不同QST分型儿童颅咽管瘤的临床特点及其在预后评估中的作用。方法回顾性纳入1998年12月至2015年12月南方医科大学南方医院神经外科收治的149例原发儿童颅咽管瘤患者,其中70例(47.0%)采用经前纵裂入路,46例(30.9%)采用经翼点入路,33例(22. 1%)釆用经蝶窦入路切除肿瘤。术后对所有患者行临床随访,包括复查鞍区MRI判断肿瘤切除程度和复发情况,根据临床症状、Kamofsky功能状态评分、生活工作情况等综合评价患儿预后。按照QST分型标准对149例患儿进行分型,比较不同类型患儿的临床特点。进一步采用多因素logistic回归分析影响患儿预后的临床因素。结果149例患儿手术均成功,其中138例(92. 6%)为全切除,11例(7.4%)为次全切除。149例患儿的中位随访时间为87个月(11 -236个月)。随访期间,134例预后良好,15例预后不良。按照QST分型标准,149例患儿中,Q型91例(Q型组),S型14例(S型组),T型44例(T型组)。3组患儿的年龄、性别、肿瘤最大径、肿瘤钙化程度、肿瘤切除程度及术后肿瘤复发间的差异均无统计学意义(均P >0.05),但在临床症状、合并脑积水、术前和术后垂体功能、手术入路及肿瘤病理学类型方面的差异均有统计学意义(均P<0.05);其中T型更常合并脑积水,Q型垂体功能更易出现异常,S型更易出现视力、视野受损。多因素logistic回归分析显示,QST分型(OR =5. 984,95% CI: 1.529 ~23.417,P =0.037)和肿瘤切除程度(OR = 8. 220,95% CI:2. 158 ~31.318,P =0.002)是影响预后的独立危险因素。结论不同QST分型颅咽管瘤患儿的临床特点不同,且QST分型是影响颅咽管瘤患儿预后的独立危险因素之一。

Objective To explore the clinical manifestation of children with different QST classification of craniopharyngioma ( CP) and its role in prognosis. Methods We retrospectively analyzed 149 children with CP who underwent surgery at Department of Neurosurgery, Nanfang Hospital of Southern Medical University from December 1998 to December 2015. Of those, 70 (47. 0%) children underwent operation through frontal base approach , 46 ( 30. 9%) through pterional approach and 33 (22. 1 %) through transsphenoidal approach for tumor removal. All patients underwent clinical follow-up after surgery, including MRI review of the sellar region to determine the tumor resection and recurrence, and measurement of relevant indicators to assess the prognosis. All 149 children were classified according to the QST classification criteria, and the differences in clinical characteristics of different types of children were analyzed. Furthermore, multivariate logistic regression analysis was used to determine the clinical factors affecting the prognosis of children. Results All children in this series underwent successful operation and 138 (92. 6%) out of those had total resection and 11 (7.4%) had subtotal resection. The median follow-up duration of 149 patients was 87 months ( range: 11 - 236 months). Good outcomes were reported in 134 patients and poor outcome in 15. In this study, 91 patients were type Q ( Q-group), 14 were type S ( Sgroup) and 44 were type T (T-group) according to the QST classification criteria. There were no significant differences in age, gender, maximum diameter, tumor calcification degree, degree of tumor resection and tumor recurrence between the 3 groups ( all P > 0. 05 ), while the clinical symptoms, incidence of hydrocephalus, pre- and post-operative pituitary function, operation approach and pathological types were significantly different in patients with different QST classifications among 149 children with CP ( all P < 0. 05). The T-type was more often associated with hydrocephalus, the Q-type was more prone to have abnormal pituitary function, and the Stype was more likely to have vision and visual field damage. Multivariate logistic regression analysis showed that QST classification( OR =5. 984,95% CI: 1.529 -23.417, P = 0.037) and degree of tumor resection( OR = 8. 220,95% CI:2. 158 -31.318 ,P =0.002) were independent prognostic factor in children with CP. Conclusions The clinical characteristics of children with different QST classification of craniopharyngioma are different, and QST classification is one of the independent risk factors affecting the prognosis of children with craniopharyngioma.