Survival and prognostic factors of early childhood medulloblastoma: an international meta-analysis.

Abstract

PURPOSE:

To assess the prognostic role of clinical parameters and histology in early childhood medulloblastoma.

PATIENTS AND METHODS:

Clinical and histologic data from 270 children younger than age 5 years diagnosed with medulloblastoma between March 1987 and July 2004 and treated within prospective trials of five national study groups were centrally analyzed.

RESULTS:

Two hundred sixty children with medulloblastoma and specified histologic subtype were eligible for analysis (median age, 1.89 years; median follow-up, 8.0 years). Rates for 8-year event-free survival (EFS) and overall survival (OS) were 55% and 76%, respectively, in 108 children with desmoplastic/nodular medulloblastoma (DNMB) or medulloblastoma with extensive nodularity (MBEN); 27% and 42%, respectively, in 145 children with classic medulloblastoma (CMB); and 14% and 14%, respectively, in seven children with large-cell/anaplastic (LC/A) medulloblastoma (P < .001). Histology (DNMB/MBEN: hazard ratio [HR], 0.44; 95% CI, 0.31 to 0.64; LC/A medulloblastoma: HR, 2.27; 95% CI, 0.95 to 5.54; P < .001 compared with CMB), incomplete resection and metastases (M0R1: HR, 1.86; 95% CI, 1.29 to 2.80; M+: HR, 2.28; 95% CI, 1.50 to 3.46; P < .001 compared with M0R0), and national group were independent prognostic factors for EFS, and OS. The HRs for OS ranged from 0.14 for localized M0 and DNMB/MBEN to 13.67 for metastatic LC/A medulloblastoma in different national groups.

CONCLUSION:

Our results confirm the high frequency of desmoplastic variants of medulloblastomas in early childhood and histopathology as a strong independent prognostic factor. A controlled de-escalation of treatment may be appropriate for young children with DNMB and MBEN in future clinical trials.

• Authors: Stefan Rutkowski, Katja von Hoff, Angela Emser, Isabella Zwiener, Torsten Pietsch, Dominique Figarella-Branger, Felice Giangaspero, David W Ellison, Maria-Luisa Garre, Veronica Biassoni, Richard G Grundy, Jonathan L Finlay, Girish Dhall, Marie-Anne Raquin, Jacques Grill
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 28 Issue 33 Pg. 4961-8 (Nov 20 2010) ISSN: 1527-7755 [Electronic] United States
• PMID: 20940197 (Publication Type: Journal Article, Meta-Analysis)

Topics

• Cerebellar Neoplasms (mortality)
• Child, Preschool
• Female
• Humans
• Infant
• Male
• Medulloblastoma (mortality)
• Multivariate Analysis
• Prognosis
• Survival Rate