Duration between onset and diagnosis in central nervous system tumors: impact on prognosis and functional outcome.
BACKGROUND
The initial presentation of central nervous system (CNS) tumors in children frequently mimics other more common and less serious conditions, resulting in diagnostic difficulty and a prolonged time to diagnosis. Yet whether early diagnosis contributes to better life prognosis and functional outcome has not been elucidated. Only a few such reports have originated from Japan, where neuroimaging techniques are the best in the world. We examined the time to diagnosis, the so-called prediagnostic symptomatic interval (PSI), and its impact on prognosis and functional outcome in children with CNS tumors.


METHODS
We reviewed the records of 127 patients aged <15 years with CNS tumors, who were treated at our two institutions between November 1993 and October 2011.


RESULTS
The median age at diagnosis was 7.2 years (range, 3 weeks-14.9 years). The male-to-female ratio was 63:64. Median PSI was 1.5 months (0-36 months). Overall survival and progression-free survival did not differ significantly between the groups, regardless of whether the PSI was longer than the median PSI. The PSI was significantly longer in patients with long-lasting clinical signs after the initial treatment than in patients with temporary symptoms only at onset. Both univariate and multivariate analysis showed that high histological grading was statistically correlated with short PSI.


CONCLUSIONS
A short PSI was significantly associated with high-grade tumors. Earlier diagnosis did not lead to better life prognosis, but possibly to better functional outcome in children with CNS tumors.
Division of Pediatric Neuro-Oncology, Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Kohei
K
Fukuoka
Division of Pediatric Neuro-Oncology, Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Takaaki
T
Yanagisawa
Division of Pediatric Neuro-Oncology, Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Tomonari
T
Suzuki
Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Mitsuaki
M
Shirahata
Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Jun-Ichi
JI
Adachi
Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Kazuhiko
K
Mishima
Department of Neurosurgery, Saitama Medical University, Moroyama, Japan.
Takamitsu
T
Fujimaki
Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Masao
M
Matsutani
Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Ryo
R
Nishikawa
D000293:Adolescent; D016543:Central Nervous System Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D008297:Male; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome
childhood brain tumor; diagnosis; pediatric neuro-oncology; prediagnostic symptomatic interval; prognosis