| Background:Medulloblastoma,the most common malignant tumor of the central nervous system in children,was first reported by Bailey and Cushing in 1925.Medulloblastoma accounts for 25%-30% of brain tumors in children,and more than40% of posterior fossa tumors in children.The majority of patients are 5 to 7 years old,and males are more than females.Although medulloblastoma occurs mostly in children,it can also be seen in adults,accounting for less than 1% of adult brain tumors.The clinical symptoms of medulloblastoma are mostly related to intracranial hypertension caused by tumor obstruction of cerebrospinal fluid circulation.Surgical resection of medulloblastoma and subsequent radiotherapy and chemotherapy can effectively prolong the survival time and improve the quality of life of patients.Even so,the prognosis of medulloblastoma remains poor.Surgery,chemotherapy and radiotherapy can improve the survival rate of patients,but they also bring serious consequences such as nervous system damage caused by surgery,cognitive impairment caused by radiotherapy and bone marrow suppression caused by chemotherapy.According to the patient’s age,postoperative tumor residual,distant metastasis and molecular typing,the risk stratification can be used to choose different treatment options.At present,the treatment of medulloblastoma has formed a standard process of surgery combined with postoperative radiotherapy and chemotherapy.At the same time,high-dose chemotherapy and surgery and chemotherapy alone for children under 3 years old are also actively carried out.However,due to the younger age of patients with medulloblastoma,the low incidence of tumor,easy dissemination along the cerebrospinal fluid,and different histopathological and molecular types of tumors,the research results of the prognosis of medulloblastoma are not the same in various clinical centers.Therefore,it is still necessary to study the clinical characteristics and prognostic factors of medulloblastoma.In this study,the patients with medulloblastoma who were hospitalized and operated in the First Hospital of Jilin University from 2015 to 2022 were collected,and the eligible cases were screened for retrospective study,aiming to find out more clinical and prognostic details of medulloblastoma.The clinical data were collected and the survival prognosis was analyzed.Objective:To study the clinical characteristics and prognostic factors of medulloblastoma,to find the factors related to the prognosis of medulloblastoma,to summarize the clinical characteristics of medulloblastoma patients and the precautions in the treatment process,and to conduct univariate and multivariate prognostic survival analysis of related factors,so as to provide guidance for clinical work.Methods:In this study,patients with medulloblastoma who underwent surgical treatment in the First Hospital of Jilin University from 2015 to 2022 were collected and followed up by telephone or medical record system.The survival time,age,gender,tumor size,tumor location,Ki-67 positive expression,platelet distribution width,preoperative hydrocephalus,tumor adhesion to brain stem,radiotherapy and chemotherapy of patients with medulloblastoma were collected,and the patients who met the inclusion criteria were screened for retrospective study.Statistical methods were used to analyze the data information.Kaplan-Meier method was used for survival analysis,and Log Rank test was used to compare the differences between groups(P < 0.05 was considered statistically significant).Finally,proportional hazards multivariate model analysis(COX regression analysis)was used to find the independent risk factors affecting the prognosis of medulloblastoma,and these factors affecting the prognosis were discussed and analyzed.Results:A total of 40 patients were included in this study,and the 3-year overall survival rate was 66.1%.There were 8 cases in adult group and 32 cases in children group.There were 22 males and 18 females.The tumor location was midline in 29 cases and peripheral in 11 cases.There were 29 cases with preoperative hydrocephalus and 11 cases without preoperative hydrocephalus.The tumors adhered to the brainstem in 25 cases and did not adhere to the brainstem in 15 cases.The maximum diameter of tumor was ≥3 cm in 34 cases and < 3 cm in 6 cases.There were 22 cases with Ki-67 expression > 30% and 18 cases with Ki-67 expression ≤30%.Thirty patients received postoperative radiotherapy and 10 patients did not.Twenty-seven patients received postoperative chemotherapy and 13 patients did not.All patients with chemotherapy received radiotherapy,and 10 patients did not receive postoperative radiotherapy or chemotherapy.Platelet distribution width was ≤10.2% in 10 cases and > 10.2% in 30 cases.Results of univariate analysis of survival analysis: Gender,age(adult group and child group),tumor diameter(< 3 cm and ≥3 cm),tumor location(midline type and peripheral type),hydrocephalus,brain stem adhesion,Ki-67 expression(≤30% and >30%)had no significant effect on the 3-year survival rate(p > 0.05).There were statistically significant differences in the effects of postoperative radiotherapy and chemotherapy and platelet distribution width(≤10.2% and > 10.2%)on the 3-year survival rate of patients(p < 0.05).The results of multivariate regression analysis of survival analysis showed that the effect of platelet distribution width(≤10.2% and >10.2%)on the 3-year survival rate of patients was not statistically different(p > 0.05),and the effect of postoperative radiotherapy and chemotherapy on the 3-year survival rate of patients was statistically significant(p < 0.05).Postoperative radiotherapy and chemotherapy are the factors affecting the prognosis of medulloblastoma.Conclusion:Postoperative chemoradiotherapy is a factor affecting the survival of patients with medulloblastoma.When the tumor is large and complicated with hydrocephalus and brain stem adhesion,active surgical resection of the tumor combined with postoperative radiotherapy and chemotherapy can also achieve good therapeutic effects.At the same time,we should strengthen the health education for patients with medulloblastoma and their families to enhance the confidence of patients in life. |
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