Spinal ependymomas: benefits of extent of resection for different histological grades.
Spinal ependymomas: benefits of extent of resection for different histological grades.
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DOI：
10.1016/j.jocn.2012.12.010
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发表时间：
2013-10
影响因子：
2
通讯作者：
Parsa, Andrew T.
中科院分区：
文献类型：
--
作者：
Oh, Michael C.;Tarapore, Phiroz E.;Kim, Joseph M.;Sun, Matthew Z.;Safaee, Michael;Kaur, Gurvinder;Aranda, Derick M.;Parsa, Andrew T.
尽管世界卫生组织(WHO)将脊椎室管膜瘤分为三个组织学级别，但WHO I级和II级肿瘤之间的手术结果差异尚不清楚。对于这些良性肿瘤，最好的预后可能是由肿瘤分级以外的因素决定的，例如切除的程度。为了分析切除范围对不同分级的脊髓室管膜瘤的影响，我们进行了全面的文献回顾，以确定接受手术切除的成年脊髓室管膜瘤患者的WHO分级。总共确认了175名患者。正如预期的那样，III级肿瘤的预后最差(P<；0.001)，而I级和II级肿瘤手术后的预后没有显著差异。总体而言，与次全切除组相比，大部切除组的无进展存活率(PFS，p<；0.001)和总存活率(OS，p=0.022)显著提高。令人惊讶的是，GTR率在II级肿瘤中最高(78.8%，78/99；p<；0.001)，其次是I级肿瘤(58.9%，33/56)和III级肿瘤(27.3%，3/11)。有趣的是，对于II级肿瘤(p<；0.001)，GRT显著改善了PFS，但对于I级肿瘤(p=0.705)。在OS中也发现了类似的趋势，尽管在统计上没有显著意义。我们的结果表明，虽然GTR提供了最好的总体结果，但GTR对经典的II级室管膜瘤最有效，但对I级室管膜瘤无效。尽管WHO分级较低，粘液乳头状室管膜瘤的GTR率较低，从GTR中获益较少。
Although the World Health Organization (WHO) categorizes spinal ependymomas into three histological grades, difference in surgical outcomes between WHO grades I and II tumors are unclear. For these benign tumors, prognosis may be best determined by factors other than tumor grade alone, such as extent of resection. To analyze the effects of the extent of resection on different grades of spinal ependymomas, we performed a comprehensive literature review to identify adult spinal ependymoma patients who received surgical resection with a clearly identifiable WHO grade. A total of 175 patients were identified. While grade III tumors carried the worst prognosis as expected (p < 0.001), grade I and II tumors did not differ significantly in outcomes following surgery. Overall, gross total resection (GTR, 68.7%, 114/166) provided significantly improved progression-free survival (PFS, p < 0.001) and overall survival (OS, p= 0.022) compared to the subtotal resection group. Surprisingly, the highest GTR rate was achieved for grade II tumors (78.8%, 78/99; p< 0.001) followed by grade I (58.9%, 33/56) and grade III tumors (27.3%, 3/11). Interestingly, PFS was significantly improved by GTR for grade II tumors (p < 0.001), but not for grade I (p = 0.705). Similar trends, although not statistically significant, were found for OS. Our results show that while GTR provides the best overall outcomes, GTR is most effective for classic grade II ependymomas, but not for grade I ependymomas. Despite having a lower WHO grade, myxopapillary ependymomas have a lower GTR rate, and benefit less from GTR.
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