背景:颅内表皮样肿瘤(ET)很少见,良性病变,由于其倾向于包裹重要的神经血管结构,在神经外科治疗中面临重大挑战。
目的:评估临床,人口统计学,和肿瘤特异性因素对手术决策的影响(总切除[GTR]vs.次全切除[STR])和结果,并确定切除后具有不同特征和结果的患者群。
方法:我们回顾性分析了1998年至2022年治疗的72例表皮样脑肿瘤患者,采用多变量logistic回归分析GTR与无进展生存期(PFS)的STR预测因子和Kaplan-Meier曲线。基于临床数据的K-原型聚类对患者进行分类。
结果:我们队列的平均年龄为39.8±20.1岁。13.9%的患者复发,中位PFS为108个月(IQR57-206)。癫痫发作显著预测GTR(p<0.05),而对关键结构的粘附降低了GTR可能性(p<0.05)。初次手术更经常实现GTR,与延长PFS(p<0.0001)和减少复发(p<0.01)相关。既往ET手术史预测肿瘤复发大小增加(p<0.05)和总体PFS降低(p<0.05)。聚类分析显示三个集群的复发率有显著差异(p<0.0001),长期神经功能缺损(p<0.05),PFS大于10年(p<0.0001),组1和组3(p<0.0001)以及组2和组3(p<0.01)之间的中位PFS存在显着差异。
结论:本研究强调了定制的手术策略在颅内ET管理中的重要性,倡导GTR尽可能优化长期结果。未来的前瞻性研究对于进一步完善治疗方法至关重要。提高ET患者的生存率。
BACKGROUND: Intracranial epidermoid tumors (ETs) are rare, benign lesions that present significant challenges in neurosurgical management due to their propensity to encase vital neurovascular structures.
OBJECTIVE: To evaluate the impact of clinical, demographic, and tumor-specific factors on surgical decisions (gross total resection [GTR] vs. subtotal resection [STR]) and outcomes and identify patient clusters with distinct profiles and outcomes post-resection.
METHODS: We retrospectively analyzed 72 epidermoid brain tumor patients treated from 1998 to 2022, employing multivariable logistic regression for GTR vs. STR predictors and Kaplan-Meier curves for progression-free survival (PFS). K-prototype clustering classified patients based on clinical data.
RESULTS: The mean age of our cohort was 39.8±20.1 years. 13.9% of patients had a recurrence, with a median PFS of 108 months (IQR 57-206). Seizures significantly predicted GTR (p<0.05), whereas adherence to critical structures reduced GTR likelihood (p<0.05). Initial surgeries more often achieved GTR, correlating with longer PFS (p<0.0001) and reduced recurrence (p<0.01). History of previous ET surgery was predictive of increased recurrent tumor size (p<0.05) and reduced overall PFS (p<0.05). Clustering analysis revealed three clusters with significant differences in recurrence rates (p<0.0001), long term neurological deficits (p<0.05), PFS greater than 10 years (p<0.0001), and significant differences in median PFS between clusters 1 and 3 (p<0.0001) as well as 2 and three (p<0.01).
CONCLUSIONS: This study emphasizes the importance of tailored surgical strategies in managing intracranial ETs, advocating for GTR to optimize long-term outcomes where possible. Future prospective studies are essential to further refine treatment approaches, enhancing survival for ET patients.