Medulloblastoma Clinical Characteristics,treatment Method And The Analysis Of Risk Factors Related To Prognosis

Background and purposeMedulloblastoma?MB?is one of the most malignant neuroepithelial neoplasms of the central nervous system,accounting for 9.2%of pediatric brain tumors in children aged 0-14 years,and about 30%of adults in MB.The tumor growth is extremely rapid,and it is not easy to be completely excised during the operation of the brain stem,and the prognosis of patients is poor when it is disseminated and planted along the cerebrospinal fluid.Although there is much progress before the effect of the treatment of patients with MB,accepted treatment is surgical cut and postoperative radiotherapy or chemoradiotherapy completely as possible,but there are scholars have challenged radiation dose,and the application scope of chemotherapy is controversial,there is no unified standard chemotherapy scheme.In recent years,the molecular fractal method of MB has been gradually recognized,and different types of signal transduction pathways have become a new way to study MB.This study by collecting cases of MB,summarized the clinical characteristics and treatment methods,analysis of different treatment methods and effect on the prognosis of disease characteristics,summarizes the factors related to the prognosis of patients with MB,to provide reference for clinical work,make the MB patients get better treatment effect.MethodsFrom January 2012 to January 2017,the first affiliated hospital of zhengzhou university was diagnosed as primary medulloblastoma by pathology and immunohistochemistry.According to the general clinical characteristics and treatment methods 50 patients with MB of gender,age,tumor location,invasion of brain stem or not,pathological types,molecular classification,the degree of resection,Chang's installment,radiation dose,radiation in auxiliary start time,tumor size,radiationdoseandwhetherchemotherapygroup.Thisstudyapplied immunohistochemistry to molecular classification of MB,and pathological classification was provided by pathology.Use the overall survival?OS?and progression-free survival?PFS?ratio to evaluate the prognosis,for data analysis,using SPSS 22.0 by Kaplan Meier method and the Log-rank test,single factor analysis and map graph to describe living conditions,the single factor analysis of statistically difference factors in multivariate Cox regression model analysis.Results1.Among the 50 patients,32 males,18 females,15?30%?of the 16 year olds,and 35 cases?70%?of 16 year olds.There were 36 cases?72%?of central type patients and 14 cases?28%?around.There were 11 cases of brain stem invasion?22%?and 39 cases?78%?.15 cases?30%?were not fully cut,and 32?64%?were all cut.34cases?64%?M₀,16?32%?M_1-4.Radiotherapy was initiated in 43 patients?86%?between 4 and 6 weeks after surgery.The tumor size was greater than 3 cm² and 42patients?84%?,<3 cm²patients 8 cases?16%?.Whether the tumor invaded the brain stem was the factor affecting the patient's OS rate for 5 years,and the differences among the groups were statistically significant?P<0.05?.Chang's staging was the factor that affected patients'PFS for 5years,and the difference between groups was statistically significant?P<0.05?.2.In the diagnosis,34 patients?68%?,15 patients?30%?,20 cases of ataxia?40%?,and 17 cases?34%?of the head circumference.After surgery,16 patients?32%?,5 cases of intracranial hematoma?10%?,2 cases of meningitis?4%?,4 cases of cerebrospinal fluid?8%?,etc.3.In this study,29 cases?58%?were CMB,15?30%?DMB and 6?12%?LC/AMB.The prognosis of patients with single factor analysis,according to the results of DMB type best,DMB type patients in this study for 5 years OS at a rate of 93.3%,while the CMB,LC/AMB 5 years in patients with OS rate is 60.7%,57.1%respectively,poor prognosis than the former,both OS 5 years rate difference was statistically significant?P<0.05?.The PFS rates of patients with DMB,CMB and LC/AMB were 86.7%,53.6%and 42.9%,respectively,with statistical significance?P<0.05?.The survival curve showed that the initial survival rate of DMB and LC/AMB was the same among patients aged 16 and older,but the DMB survival rate was higher after 38 months.In patients<16 years old,the OS survival curve of DMB is better than that of LC/AMB type.The results of multivariate analysis showed that there was statistically significant difference between the pathological classification groups?P<0.05?.4.In this study,13 cases?26%?SHH,11?22%?WNT,26?52%?were non-shh/WNT.WNT,SHH and non-wnt/SHH type 5 years were 84.3%,78.4%and 65.2%respectively,with statistically significant differences between groups?P<0.05?.In the five years,the PFS rate was 55.8%,62.9%and 38.2%respectively,and there was no statistically significant difference between the groups?P>0.05?.5.Whether the tumor is fully cut is the factor that significantly affects the 5-year OS rate and 5-year PFS rate of MB patients,and the differences among the groups are statistically significant?P<0.05?.The results of multivariate analysis showed that there was a statistically significant difference in the survival difference between the whole and the uncut group?P<0.05?.6.The 5-year OS and PFS rates of patients receiving radiotherapy and chemoradiotherapy were 71.4%and 69.4%,58.3%and 49.2%,respectively.There was no significant difference between the five years'OS rate and the 5-year PFS rate in each group?P>0.05?.There was no significant difference in survival curves between postoperative radiotherapy and radiotherapy and chemotherapy.7.There was significant difference in the 5-year PFS rate difference between the patients receiving the total brain 36 Gy and the patients with cranial fossa over 55 Gy or above and the patients who ended other radiotherapy doses?P<0.05?.Conclusion1.The degree of tumor resection and pathological typing are independent risk factors affecting the prognosis of MB patients.Among different pathological types,DMB had the highest survival rate,followed by CMB survival rate,and the survival rate of LC/AMB was significantly lower.In patients with or above 16 years of age,DMB was comparable to that in the previous 38 months of LC/AMB.In patients with16 years of age,DMB was better than LC/AMB patients.It may be related to higher radiotherapy dose for patients with or greater than 16 years of LC/AMB type,and may be caused by insufficient number of cases in this study,which requires a large amount of data to further verify and find the cause.2.Non-WNT/SHH type was the most in MB molecular subtype,followed by SHH type,WNT type was the least,and WNT subtype had the best prognosis.The better prognosis of WNT subtype may be due to its sensitivity to radiotherapy.The average observation period of this study is 33 months,and the observation period needs to be extended to further study this view.3.The mortality of recurrent patients is high,and large dose radiation can reduce the risk of recurrence.The symptoms or complications of Chang's stage and>2 May be related to the recurrence of the disease and need to further study the factors associated with recurrence and seek effective solutions for the treatment of recurrence.