PROGNOSTIC FACTORS IN MEDULLOBLASTOMA, INCLUDING DNA PLOIDY

被引:58
作者
ZERBINI, C
GELBER, RD
WEINBERG, D
SALLAN, SE
BARNES, P
KUPSKY, W
SCOTT, RM
TARBELL, NJ
机构
[1] CHILDRENS HOSP MED CTR,DEPT RADIAT ONCOL,300 LONGWOOD AVE,BOSTON,MA 02115
[2] JOINT CTR RADIAT THERAPY,BOSTON,MA
[3] CHILDRENS HOSP MED CTR,DEPT PATHOL,BOSTON,MA 02115
[4] CHILDRENS HOSP MED CTR,DEPT SURG,BOSTON,MA 02115
[5] CHILDRENS HOSP MED CTR,DEPT RADIOL,BOSTON,MA 02115
[6] HARVARD UNIV,SCH MED,DANA FARBER CANC INST,DIV BIOSTAT,BOSTON,MA 02115
[7] HARVARD UNIV,SCH MED,DANA FARBER CANC INST,DEPT PEDIAT,BOSTON,MA 02115
[8] BRIGHAM & WOMENS HOSP,CTR BRAIN TUMOR,BOSTON,MA 02115
[9] BRIGHAM & WOMENS HOSP,DEPT PATHOL,BOSTON,MA 02115
[10] HARVARD UNIV,SCH PUBL HLTH,DEPT BIOSTAT,BOSTON,MA 02115
[11] HARVARD UNIV,SCH MED,BOSTON,MA 02115
关键词
D O I
10.1200/JCO.1993.11.4.616
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose; DNA ploidy status, completeness of surgical resection, use of chemotherapy, adequacy of radiation therapy, metastatic stage, sex, and age at diagnosis were evaluated as predictors of relapse in 58 patients with cerebellar medulloblastoma. Methods; Flow cytometry (FCM) and/or image analysis (IA) were used to characterize tumor DNA ploidy. Twelve tumors (21%) were found to be aneuploid, 11 (19%) tetraploid, and 35 (60%) diploid. Results; The most significant predictors of relapse in univariate analyses were the adequacy of radiation (≥ 50 Gy) (P = .02), metastatic staging (P = .05), completeness of resection (P = .085), and DNA ploidy status (diploid/tetraploid v aneuploid; P = .11). When the 52 patients who received ≥ 50 Gy were included in a multivariate Cox model analysis, those with diploid/tetraploid tumors had fewer recurrences than those with aneuploid tumors (relative risk, 0.33; 95% confidence interval, 0.12 to 0.89; P = .03). Patients with complete resections (P = .07), or with stage MO disease (P = .06) had fewer recurrences than other patients, but these factors were not independent predictors of outcome. DNA ploidy status was correlated with age; 10 of the 12 aneuploid tumors were found in children ages 3 to 10 years. Age, sex, and the use of chemotherapy were not prognostically significant in these analyses. Conclusion; The adequacy of radiation dose and DNA ploidy were the most important prognostic factors in this series. Contrary to previous reports, when corrected for adequacy of treatment, DNA aneuploidy was associated with a poor outcome. By multivariate analyses, DNA ploidy was an independent variable, even when controlling for extent of surgical resection and metastatic stage. © 1993 by American Society of Clinical Oncology.
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收藏
页码:616 / 622
页数:7
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