Analysis of risk factors of medulloblastoma recurrence based on the molecular subgroups

Abstract

Objective To investigate the recurrence rate and risk factors for the patients with medulloblastoma based on the molecular subgroups. Methods A retrospective study was conducted for the clinicopathological data of 67 medulloblastoma patients who were admitted in Department of Radiotherapy and Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from March 2011 to November 2013. All the cases received the MRI examinations to identify the location, aggressiveness, dissemination, stage and resection as well as the histological and molecular pathology in order to analyze the recurrence rate. The Kaplan⁃Meier survival curve and Cox regression were performed to detect the risk factors for medulloblastoma recurrences. Based on the recurrence, this cohort of samples were divided into recurrence group (n=22) and non⁃recurrence group (n=45). Results Among the patients, the overall survival rate was 71.64% (48/67), the progression⁃free survival rate was 67.16% (45/67), the recurrece rate was 32.84% (22/67), and the fatality rate was 28.36% (19/67). The fatality rate in the recurrence group was significantly higher than that in the non⁃recurrence group [81.82% (18/22) vs. 2.22% (1/45); χ²=46.078, P=0.000]. The Kaplan⁃Meier survival curves showed that patients with lateral medulloblastoma have a shorter median survival time than those with middle medulloblastoma (18 months vs. 51 months, P=0.000), patients with large cell/anaplasitc medulloblastoma suffered from a poorer median survival time compared with the classic medulloblastoma, desmoplastic/nodular medulloblastoma and medulloblastoma with extensive nodularity (10 months vs. 50, 44 and 31 months; P=0.000), median survival time of patients with SHH⁃activated subtype was shorter than that of patients with the other three subgroups (19 months vs. 32, 33 and 57 months; P=0.003), and median survial time of patients with recurrence was shorter than that of patients with non⁃recurrence (19 months vs. 60 months, P=0.000). The Cox regression analysis showed that lateral medulloblastoma (RR=3.514, 95%CI: 1.262-9.781; P=0.016), large cell/anaplasitc medulloblastoma (RR=6.452, 95%CI: 1.320-31.537; P=0.021) and Group 3 (RR=4.289, 95%CI: 1.359-13.533; P=0.013) subtype were the risk factors for medulloblastoma recurrence. Conclusions Patients with lateral medulloblastoma, large cell/anaplasitc medulloblastoma and SHH⁃activated subtype suffered from a poorer survival. Patients with lateral, large cell/anaplasitc medulloblastoma and Group 3 subtype were prone to recurrence.

doi：10.3969/j.issn.1672⁃6731.2021.12.011