Clinical and molecular parameters for risk stratification in Mexican children with medulloblastoma.
BACKGROUND
Clinical, histological, and more recently, molecular factors have been described as important in survival of the patient with medulloblastoma. Best survival results include aggressive chemotherapeutic protocols. More exact risk analysis may differentiate patients who require aggressive treatments from those with low risk who may respond adequately to less aggressive protocols.


METHODS
Twenty six patients were included over a 10-year period and were followed for at least 5 years. Personal variables were obtained from their clinical records. Immunochemistry studies were performed on their formalin-fixed paraffin-embedded tissues. Statistical analysis included chi(2) test, odds risk, linear regression models, and Kaplan-Meier survival analysis.


RESULTS
Metastatic disease and chemotherapy with VP16-carboplatin reduce the patient's probability of survival, whereas anaplastic histology increases the probability of death. Global survival and disease-free survival were 66.6 and 45.02%, respectively. Only two patients overexpressed the ERBB2 protein, and no significant difference was found in survival in terms of ERBB2 overexpression.


CONCLUSIONS
Risk stratification has become very important in medulloblastoma. We found an increased hazard of death when metastatic disease was present. Gene expression in Mexican children requires a larger sample in order to be analyzed.
López-Aguilar
Enrique
E
Oncology Department, UMAE, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico. elopezaguilar@hotmail.com
Sepúlveda-Vildósola
Ana Carolina
AC
Rivera-Márquez
Hugo
H
Siordia-Reyes
Georgina
G
Betanzos-Cabrera
Yadira
Y
Cerecedo-Díaz
Fernando
F
del Angel
Volkmar Wanzke
VW
Diegopérez-Ramírez
Jaime
J
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002528:Cerebellar Neoplasms / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007223:Infant; D008297:Male; D008527:Medulloblastoma / Q000401:mortality*; D008800:Mexico / Q000453:epidemiology; D011336:Probability; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics; D012306:Risk; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors
D016190:Carboplatin; D005047:Etoposide; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human