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Staging, scoring and grading of medulloblastoma

A postoperative prognosis predicting system based on the cases of a single institute

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Summary

Although recently survival of some medulloblastoma patients increased remarcably, it remains a serious diagnosis in others. In order to predict the postoperative prognosis in patients treated for medulloblastoma, a new staging, scoring and grading system was developed.

Sixty-six patients operated on microsurgically between 1975 and 1990 at a single neurosurgical center were fully followed-up. No patient was excluded due to a poor postoperative course. Completion of commonly used radiotherapy protocols was attempted in all patients. Survival of patients was evaluated by the Kaplan-Meier method.

The following 5 parameters were selected to define subgroups: patients' age, tumour location and histology, degree of resection and presence or absence of metastases. Patients older than 10 years had a better prognosis than individuals aged 10 or less (p<0.01), patients with lateral tumours had a better prognosis than patients with midline tumours with brain stem infiltration (p<0.05), patients with complete tumour resection had a more favourable prognosis than individuals with subtotal (p<0.01) or partial resection (p<0.001), patients without metastases at the time of diagnosis had a better prognosis than individuals without such evidence (p<0.001), patients with the desmoplastic tumour variant had a better prognosis than patients with classical tumour histology (p<0.01).

According to the prognosis of a distinct subgroup, scoring points were distributed which correlated with the degree of inter-subgroup significances. The sum of a single patient's scoring points was called the total score. Based on this score, three groups of prognosis were distinguished. The good prognosis group (n=29) showed a significantly better survival (p<0.05) than the moderate prognosis group (n=26), whereas the moderate prognosis group had a significantly better survival (p<0.05) than the poor prognosis group (n=11). A Kaplan-Meier survival rate of 62% was found in patients of the good prognosis group, a rate of 22% in the moderate prognosis group, and a rate of 0% in the poor prognosis group.

It is concluded that this new staging, scoring and grading system is a simple and recommendable prognostic system for all patients treated surgically for medulloblastoma.

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Authors and Affiliations

  1. Neurochirurgische Universitätsklinik Freiburg, Freiburg i. Br., Federal Republic of Germany

    U. Sure, W. J. Berghorn, H. Bertalanffy & W. Seeger

  2. Department of Neurosurgery, Nagoya University, School of Medicine, Tsurumai Showa, Nagoya, Japan

    U. Sure, T. Wakabayashi, J. Yoshida & K. Sugita

  3. Neurochirurgische Universitätsklinik Aachen, RWTH, Aachen, Federal Republic of Germany

    U. Sure & H. Bertalanffy

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  1. U. Sure
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  4. T. Wakabayashi
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  5. J. Yoshida
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  7. W. Seeger
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Sure, U., Berghorn, W.J., Bertalanffy, H. et al. Staging, scoring and grading of medulloblastoma. Acta neurochir 132, 59–65 (1995). https://doi.org/10.1007/BF01404849

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