Differences in the prognostic value of tumor extent of resection among the molecular subgroups of medulloblastoma:A single centre study of 113 cases
Yuyuan Wang1, Kay Kawai Li2, Ji Xiong3, Zhenyu Zhang4, Yang Wang5, Jian Xu1, Yin Wang3, Hokeung Ng2, Ping Zhong1
1 Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China;
2 Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong 999077, China;
3 Department of Pathology, Huashan Hospital, Fudan University, Shanghai 200040, China;
4 Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450052, China;
5 Department of Radiotherapy, Huashan Hospital, Fudan University, Shanghai 200040, China
Differences in the prognostic value of tumor extent of resection among the molecular subgroups of medulloblastoma:A single centre study of 113 cases
Yuyuan Wang1, Kay Kawai Li2, Ji Xiong3, Zhenyu Zhang4, Yang Wang5, Jian Xu1, Yin Wang3, Hokeung Ng2, Ping Zhong1
1 Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China;
2 Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong 999077, China;
3 Department of Pathology, Huashan Hospital, Fudan University, Shanghai 200040, China;
4 Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450052, China;
5 Department of Radiotherapy, Huashan Hospital, Fudan University, Shanghai 200040, China
摘要 Medulloblastoma (MB) is one of the most common pediatrics malignant tumors of the central nervous system.Studies in America and Europe have demonstrated significant differences in the prognostic value of medulloblastoma extent among molecular subgroups of medulloblastoma.However,studies focusing on the Chinese population are still lacking.A total of 113 patients with medulloblastoma who underwent surgical resection in Huashan Hospital between January 2002 and December 2013 were included in this study.Histological diagnoses were confirmed by 2 or more pathologists.Immunohistochemistry and CTNNB1 exon 3 mutation analysis were used to determine the different subgroups.Complete or incomplete resection was defined based on surgeons' reports and confirmed by postoperative computer tomography (CT).In this study,we included 113 patients with medulloblastoma (13 with WNT subgroup,18 with SHH subgroup,and 82 with non-SHH/WNT subgroups) to assess their event-free and overall survival.We identified event-free survival and overall survival benefit for complete resection over incomplete resection.We found that for patients with NON-SHH/WNT medulloblastoma,incomplete resection was significantly associated with progression and overall survival compared with complete resection.To our best knowledge,the present study is the first to demonstrate the prognostic value of tumor extent of resection among the molecular subgroups of 113 medulloblastoma in the Chinese population.The prognostic benefit of the increased extent of resection for patients with medulloblastoma is attenuated after the molecular subgroups are taken into account.We still need further study to assess the benefit of surgical resection of small residual portions.
Abstract: Medulloblastoma (MB) is one of the most common pediatrics malignant tumors of the central nervous system.Studies in America and Europe have demonstrated significant differences in the prognostic value of medulloblastoma extent among molecular subgroups of medulloblastoma.However,studies focusing on the Chinese population are still lacking.A total of 113 patients with medulloblastoma who underwent surgical resection in Huashan Hospital between January 2002 and December 2013 were included in this study.Histological diagnoses were confirmed by 2 or more pathologists.Immunohistochemistry and CTNNB1 exon 3 mutation analysis were used to determine the different subgroups.Complete or incomplete resection was defined based on surgeons' reports and confirmed by postoperative computer tomography (CT).In this study,we included 113 patients with medulloblastoma (13 with WNT subgroup,18 with SHH subgroup,and 82 with non-SHH/WNT subgroups) to assess their event-free and overall survival.We identified event-free survival and overall survival benefit for complete resection over incomplete resection.We found that for patients with NON-SHH/WNT medulloblastoma,incomplete resection was significantly associated with progression and overall survival compared with complete resection.To our best knowledge,the present study is the first to demonstrate the prognostic value of tumor extent of resection among the molecular subgroups of 113 medulloblastoma in the Chinese population.The prognostic benefit of the increased extent of resection for patients with medulloblastoma is attenuated after the molecular subgroups are taken into account.We still need further study to assess the benefit of surgical resection of small residual portions.
Yuyuan Wang, Kay Kawai Li, Ji Xiong, Zhenyu Zhang, Yang Wang, Jian Xu, Yin Wang, Hokeung Ng, Ping Zhong. Differences in the prognostic value of tumor extent of resection among the molecular subgroups of medulloblastoma:A single centre study of 113 cases[J]. 临床转化神经科学, 2017, 3(2): 66-73.
Yuyuan Wang, Kay Kawai Li, Ji Xiong, Zhenyu Zhang, Yang Wang, Jian Xu, Yin Wang, Hokeung Ng, Ping Zhong. Differences in the prognostic value of tumor extent of resection among the molecular subgroups of medulloblastoma:A single centre study of 113 cases. Translational Neuroscience and Clinics, 2017, 3(2): 66-73.
20170712151548 Table 2 Immunoreactivity patterns of SHH, WNT, and Non-SHH/WNT molecular subgroups*.
20170712151559 Figure 1 IHC staining of medulloblastoma FFPE. GAB1, CTNNB1, Filamin A, and YAP1 antibodies were used to determine the different subgroups. IHC: Immunohistochemistry; FFPE: formalinfixed paraffin embedded.
20170712151610 Figure 2 Sequencing performed to confirm the mutation exon 3 of CTNNB1 in FFPE slides. FFPE: formalin-fixed paraffin embedded.
20170712151619 Table 3 Case number and percentage of SHH, WNT, and Non-SHH/WNT molecular subgroups.
20170712151631 Figure 3 The overall and event-free survival for extent of resection by subgroup. The molecular subgroups are WNT, SHH, and NON-SHH\WNT. Numbers in the parentheses are failure events during that time period. P values are based on the log-rank test across the two strata (Complete resection vs. Incomplete resection).
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2017, Vol. 3 
