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Teratomas of the cranial vault: a systematic analysis of clinical outcomes stratified by histopathological subtypes

  • Original Article - Brain Tumors
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Abstract

Background

Teratomas of the cranial vault are divided into histopathological subtypes and grouped by prognoses: mature (good prognosis), mixed/malignant and immature teratomas (intermediate prognosis). This schema also includes non-teratomatous tumors. The authors of this study sought to elucidate histologically dependent predictors of survival and further clarify the classification system of intracranial teratomas.

Methods

We performed a systematic analysis of the published literature to identify studies describing patients with intracranial teratomas diagnosed with magnetic resonance imaging (MRI) and presenting definite information on histologies, therapies, and outcomes at a minimum follow-up of 2 years. Disease-free (DFS) and overall survival (OS) were evaluated.

Results

A total of 18 articles comprised of 134 patients were included. On univariate analysis, male sex and gross-total resection (GTR) were associated with high mean DFS (p = 0.0362 and p < 0.0001, respectively). On multivariate analysis, mature teratomas located in the pineal, and those having undergone subtotal resection (STR) demonstrated high mean OS (p = 0.0023 and p = 0.0044, respectively). Mature and mixed/malignant suprasellar teratomas had equally higher mean OS versus immature suprasellar teratomas (p < 0.0001). Mature and immature teratomas treated with adjuvant therapy had significantly higher mean OS compared to those managed with surgery alone (p = 0.0421 and p = 0.0423, respectively). Males with immature teratomas had the highest mean OS (p < 0.0001). Immature teratomas managed with surgery alone had higher mean DFS, but lower mean OS, compared to those treated with adjuvant therapy (p = 0.0176 and p = 0.0423, respectively).

Conclusions

Our data highlight the divergent nature of the different histopathological subtypes of teratomas, and suggest that survival outcomes are multifactorial. Specifically, male sex, pineal, suprasellar, GTR, and STR were dependent predictors of OS, while histopathology was an independent predictor of OS.

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Acknowledgements

Carlito Lagman is partially supported by a Gurtin Skull Base Research Fellowship. Timothy T. Bui is a recipient of the David Geffen Medical Scholarship. Lawrance K. Chung is partially supported by an AMA foundation Seed Grant and an AΩA Carolyn L. Kuckein Student Research Fellowship. Isaac Yang is partially supported by a Visionary Fund Grant, an Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research UCLA Scholars in Translational Medicine Program Award, the Jason Dessel Memorial Seed Grant, the UCLA Honberger Endowment Brain Tumor Research Seed Grant and the Stop Cancer (US) Research Career Development Award.

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    Authors and Affiliations

    1. Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, Los Angeles, 90095-1761, CA, USA

      Carlito Lagman, Timothy T. Bui, Brittany L. Voth, Lawrance K. Chung, David J. Seo, Courtney Duong, Mark R. Libowitz, Naomi E. Walker, Daniel T. Nagasawa & Isaac Yang

    2. Department of Radiation Oncology, University of California, Los Angeles, 300 Stein Plaza, Los Angeles, 90095-1761, CA, USA

      Isaac Yang

    3. Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, 90024, CA, USA

      Isaac Yang

    Authors
    1. Carlito Lagman
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    2. Timothy T. Bui
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    3. Brittany L. Voth
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    4. Lawrance K. Chung
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    5. David J. Seo
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    6. Courtney Duong
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    7. Mark R. Libowitz
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    8. Naomi E. Walker
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    9. Daniel T. Nagasawa
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    10. Isaac Yang
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    Corresponding author

    Correspondence to Isaac Yang.

    Ethics declarations

    This study is a systematic analysis and therefore is exempt from Institutional Review Board approval.

    Disclosures of potential conflicts of interest

    All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; participation in speakers’ bureaus; membership, employment, consultancies, stock of ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

    Research involving human participants and/or animals

    Not applicable.

    Informed consent

    This type of study does not require formal consent.

    Additional information

    Carlito Lagman and Timothy T. Bui contributed equally to this work.

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    Cite this article

    Lagman, C., Bui, T.T., Voth, B.L. et al. Teratomas of the cranial vault: a systematic analysis of clinical outcomes stratified by histopathological subtypes. Acta Neurochir 159, 423–433 (2017). https://doi.org/10.1007/s00701-016-3064-1

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    • DOI: https://doi.org/10.1007/s00701-016-3064-1

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