Brainstem gangliogliomas: prognostic factors, surgical indications and functional outcomes.
To explore the prognostic factors and discuss the surgical indications of brainstem gangliogliomas. Twenty-one patients with brainstem ganglioglioma were surgically treated at our hospital between 2006 and 2014. The clinical, radiological, operative, and pathological findings of these patients were retrospectively reviewed. The 3-years overall survival and event-free survival (EFS) rates were 90.5 % and 68.4 %, respectively. Four patients (4/18, 22 %) experienced a recurrence with a mean recurrence-free survival of 5.5 months and a mean follow-up of 37 months. Three patients died of surgery-related complications. Three growth patterns were identified: exophytic (6/21), intrinsic (2/21), and endo-exophytic (13/21). Eight patients (8/15, 53 %) harbored a BRAF V600E mutation. All recurrent tumors were endo-exophytic, and except the one without molecular information, were BRAF V600E mutants. A Cox hazard proportion ratio model was used to identify factors influencing EFS, including sex, age, location, growth patterns, extent of resection (EOR), and BRAF V600E mutation status. On univariate analysis, none of these factors reached statistical significance. Among them, EOR and growth patterns were strongly associated with each other (Fisher's exact test, P < 0.01). A multivariate analysis demonstrated that growth patterns were the only factor associated with EFS (P = 0.02; HR 49.05; 95 % CI 1.76-1365.13). Growth patterns may be useful to select surgery candidates and predict prognosis for patients with brainstem gangliogliomas. BRAF V600E was frequently present and appeared to be associated with shorter recurrence-free survival. Studies on BRAF V600E-targeted therapy for patients with high surgical risks are needed.
Medical Center, Tsinghua University, Haidian District, Beijing, 100084, China.|Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.|China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.
Chang-Cun
CC
Pan
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.|China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.
Xin
X
Chen
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.|China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.
Cheng
C
Xu
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.|China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.
Wen-Hao
WH
Wu
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.|China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.
Peng
P
Zhang
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.|China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.
Yu
Y
Wang
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.|China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.
Tao
T
Wu
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.|China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.
Jie
J
Tang
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.|China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.
Xin-Ru
XR
Xiao
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.|China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.
Zhen
Z
Wu
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.|China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing, 100050, China.
Jun-Ting
JT
Zhang
Medical Center, Tsinghua University, Haidian District, Beijing, 100084, China. zhangliweittyy@163.com.|Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China. zhangliweittyy@163.com.|China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing, 100050, China. zhangliweittyy@163.com.
Li-Wei
LW
Zhang
D000293:Adolescent; D000328:Adult; D001933:Brain Stem / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D020295:Brain Stem Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018303:Ganglioglioma / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf
BRAF V600E; Brainstem; Ganglioglioma; Prognosis; Surgical indications