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Gross total resection improves overall survival in children with choroid plexus carcinoma

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Abstract

Choroid plexus carcinoma (CPC) is a rare, malignant, primary brain tumor with a poor prognosis. While previous reports have shown benefits of aggressive surgery, very few large-scale studies have focused exclusively on the pediatric population, for whom the risks of aggressive surgery must be weighed carefully against the benefits. We performed a comprehensive systematic review of pediatric CPCs to test the effects of gross total resection (GTR) on overall survival (OS) and progression-free survival (PFS). A Pubmed search was performed to identify children with CPC who underwent surgical resection. Only disaggregated clinical cases in which extent of resection was confirmed by CT or MRI were included for analysis. Kaplan–Meier and multivariate Cox regression survival analyses were performed to determine the effects of extent of resection on OS and PFS. Disaggregated clinical data from a total of 102 pediatric CPC patients (age ≤18 years) with known extent of resection and overall survival were analyzed. GTR was significantly associated with better OS by Kaplan–Meier analysis (logrank p < 0.001). Multivariate Cox regression analysis adjusting for age, gender, tumor location (supratentorial vs. infratentorial), and type of adjuvant therapy (chemotherapy, radiation, and combined therapy), showed that GTR independently increased OS (p = 0.006). While GTR also improved PFS on Kaplan–Meier analysis (p = 0.027), the effect did not meet our criteria for significance in our multivariate Cox model (p = 0.120). GTR improved OS of pediatric CPC and is recommended if it can be safely performed.

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Abbreviations

GTR:

Gross total resection

STR:

Subtotal resection

OS:

Overall survival

PFS:

Progression free survival

EOR:

Extent of resection

CI:

Confidence interval

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Acknowledgments

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Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Funding

M. Z. Sun is a Howard Hughes Medical Institute Medical Research Fellow. M. Safaee was supported by a grant from the Doris Duke Charitable Foundation. Dr. Oh received a National Research Service Award from the National Institutes of Health (F32NS073326-01). Dr. Ivan is funded by the National Research Education Foundation through the American Association of Neurological Surgeons. Dr. Parsa was partially funded by the Reza and Georgianna Khatib Endowed Chair in Skull Base Tumor Surgery and currently by the Michael J. Marchese Professor Chair.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave., San Francisco, CA, 94117, USA

    Matthew Z. Sun, Michael E. Ivan, Aaron J. Clark, Michael C. Oh, Arthur R. Delance, Michael Safaee, Annette Molinaro & Nalin Gupta

  2. Department of Pediatrics, University of California San Francisco, 505 Parnassus Ave., San Francisco, CA, 94117, USA

    Nalin Gupta

  3. Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611-2922, USA

    Taemin Oh, Gurvinder Kaur, Orin Bloch & Andrew T. Parsa

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  1. Matthew Z. Sun
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  2. Michael E. Ivan
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  7. Michael Safaee
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Correspondence to Andrew T. Parsa.

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Sun, M.Z., Ivan, M.E., Clark, A.J. et al. Gross total resection improves overall survival in children with choroid plexus carcinoma. J Neurooncol 116, 179–185 (2014). https://doi.org/10.1007/s11060-013-1281-5

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