The relative patient benefit of gross total resection in adult choroid plexus papillomas
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Published on: January 17, 2018
Michael Safaee1, Michael C Oh, Michael E Sughrue
1Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143-0112, USA.
Insights
Gross total resection (GTR) significantly improves survival for adult choroid plexus papillomas. This study highlights that these tumors may be more aggressive in adults than previously believed, emphasizing the importance of GTR.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Choroid plexus papillomas (CPPs) are rare neuroepithelial tumors predominantly affecting children.
- Limited literature exists on CPPs specifically in the adult population.
- Understanding adult CPP behavior and optimal surgical management is crucial.
Purpose of the Study:
- To evaluate the benefits of gross total resection (GTR) versus subtotal resection (STR) for adult CPPs.
- To characterize the natural history and long-term outcomes of CPPs in adults.
- To identify prognostic factors influencing recurrence and survival.
Main Methods:
- Comprehensive PubMed search for adult CPP surgical cases with reported outcomes.
- Kaplan-Meier analysis for progression-free survival (PFS) and overall survival (OS).
- Multivariate Cox proportional hazards models to assess recurrence and survival predictors.
Main Results:
- 193 adult patients identified (mean age 39.9 years).
- GTR (72%) was associated with significantly improved PFS (p=0.015) and OS (p=0.004) compared to STR (28%).
- GTR was the sole predictor of reduced recurrence (HR=0.47), while both age and GTR impacted OS.
Conclusions:
- Gross total resection is a critical factor for improved outcomes in adult choroid plexus papillomas.
- Adult CPPs may exhibit a more aggressive natural history than previously assumed.
- While GTR is preferred, it does not guarantee a cure, necessitating continued monitoring.
Abstract:
Choroid plexus papillomas are rare neuroepithelial tumors found mainly in children. Although well studied in the pediatric population, there is a paucity of literature focusing specifically on adults. We sought to assess the relative advantage of gross total resection (GTR) and further characterize the natural history of this disease in adults. A comprehensive PubMed search was performed to identify adults who underwent surgical resection for choroid plexus papillomas with clearly reported age, tumor location, and extent of resection. Kaplan-Meier analysis was used to assess progression-free survival (PFS) and overall survival (OS). Multivariate analysis was performed using Cox proportional hazards models. A total of 193 patients were identified with a mean age of 39.9 ± 1.1 years. GTR was achieved in 72% of patients with subtotal resection (STR) in 28%. GTR was associated with a significant increase in both PFS (p = 0.015) and OS (p = 0.004) compared to STR. In a multivariate Cox proportional hazards model we found that only GTR was associated with recurrence (hazard ratio [HR] = 0.47, 95% confidence interval [CI] 0.25-0.90), while both age (HR = 1.03, 95% CI 1.00-1.05) and GTR (HR = 0.36, 95% CI 0.17-0.78) were associated with OS. Interestingly, our observed recurrence and death rates were higher than those in previously published studies. These findings demonstrate the benefit of GTR for the treatment of choroid plexus papillomas in adults. Our analysis suggests that these lesions are not as indolent as previously thought and while GTR is preferred, it is not always curative.