儿童胶质母细胞瘤:单中心治疗经验

Glioblastoma in children:therapeutic experience from a single center

目的 回顾性分析儿童胶质母细胞瘤的临床病理特征,治疗相关的预后因素,探索儿童胶质母细胞瘤的临床诊疗新思路.方法 从2009年11月至2018年12月,广东三九脑科医院肿瘤科收治31例18岁以下儿童胶质母细胞瘤患者,收集临床资料,对其临床病理特征总结,并对疗效进行评估.结果 共31例18岁以下的胶质母细胞瘤患者接受了手术及术后放化疗.年龄范围0.8-18岁,中位年龄13.8岁,男性19例,女性12例,男女比例为1.6∶1.根据磁共振T1+C相评估患者手术切除程度,其中全切15例,2例近全切,10例部分切除,4例活检术.术后3岁以上27例患儿均接受术后放疗,4例患儿未接受放疗.至2019年4月1日,31例患者中2例失访,随访时间为4-80个月.死亡13例,16例仍生存,最长生存者生存时间80个月.中位生存时间16.4个月,1年期生存率为64%,2年生存率为38%.预后因素分析中,患者手术切除术程度≥90%的患儿中位生存时间为18个月(95%CI:15.9-20个月),对比切除程度<90%的患儿中位总生存时间11个月(95%CI:9.9-12个月),差异有统计学意义(P=0.027).多因素分析显示肿瘤切除程度是预后的唯一影响因素.结论 胶质母细胞瘤患儿的生存率仍然很低,实现肿瘤全切或近全切儿童胶质母细胞瘤预后更好.

Objective To explore novel approaches to clinical diagnosis and treatment of pediatric GBM by analyzing both clinicopathologic characteristics and treatment-related prognostic factors of pediatric GBM patients.Methods The clinical data of 31 pediatric GBM patients under 18 and admitted to the Oncology Department of Guangdong Sanjiu Neurology Hospital between November 2009 and December 2018 was collected.The clinicopathologic features of these patients were summarized and therapeutic efficacy was assessed.Results A total of 31 pediatric GBM patients under the age of 18 underwent surgery and postoperative chemoradiotherapy,whose age ranged from 0.8 to 18 years old,with the median age of 13.8 years old.There were 19 male and 12 female patients,so the male-to-female ratio was 1.6:1.According to the MRI T1+C phase evaluation of the extent of surgical resection,15 cases received gross total surgical resection,2 cases underwent near-total resection,10 cases experienced partial resection,and 4 cases had biopsies.Postoperatively,27 patients over 3 years old received postoperative radiotherapy,but 4 patients did not.Among the 31 patients,2 were lost to follow-up as of April 1st,2019.The follow-up lasted 4 to 80 months.Thirteen patients died while 16 were still alive.The longest survival time was 80 months while the median survival time was 16.4 months,with the 1-year and 2-year survival rates being 64%and 38%respectively.Analysis of prognostic factors showed that the median survival time of pediatric patients with a surgical resection degree≥90%was 18 months(95%CI:15.9-20 months),compared with 11 months(95%CI:9.9-12 months)for those with a survival resection degree<90%.The difference between the two groups was statistically significant(P=0.027).Multifactorial analysis indicated that the extent of tumor resection was the sole determinant of prognosis. Conclusion The survival rate of pediatric GBM patients remains extremely low. The prognosis of pediatric GBM patients who have undergone gross total or near-total resections is more favorable.