Teratomas of the cranial vault: a systematic analysis of clinical outcomes stratified by histopathological subtypes

Carlito Lagman; Timothy T Bui; Brittany L Voth; Lawrance K Chung; David J Seo; Courtney Duong; Mark R Libowitz; Naomi E Walker; Daniel T Nagasawa; Isaac Yang

doi:10.1007/s00701-016-3064-1

Teratomas of the cranial vault: a systematic analysis of clinical outcomes stratified by histopathological subtypes

Acta Neurochir (Wien). 2017 Mar;159(3):423-433. doi: 10.1007/s00701-016-3064-1. Epub 2017 Jan 14.

Authors

Affiliations

¹ Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, Los Angeles, 90095-1761, CA, USA.
² Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, Los Angeles, 90095-1761, CA, USA. [email protected].
³ Department of Radiation Oncology, University of California, Los Angeles, 300 Stein Plaza, Los Angeles, 90095-1761, CA, USA. [email protected].
⁴ Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, 90024, CA, USA. [email protected].

PMID: 28091817
DOI: 10.1007/s00701-016-3064-1

Abstract

Background: Teratomas of the cranial vault are divided into histopathological subtypes and grouped by prognoses: mature (good prognosis), mixed/malignant and immature teratomas (intermediate prognosis). This schema also includes non-teratomatous tumors. The authors of this study sought to elucidate histologically dependent predictors of survival and further clarify the classification system of intracranial teratomas.

Methods: We performed a systematic analysis of the published literature to identify studies describing patients with intracranial teratomas diagnosed with magnetic resonance imaging (MRI) and presenting definite information on histologies, therapies, and outcomes at a minimum follow-up of 2 years. Disease-free (DFS) and overall survival (OS) were evaluated.

Results: A total of 18 articles comprised of 134 patients were included. On univariate analysis, male sex and gross-total resection (GTR) were associated with high mean DFS (p = 0.0362 and p < 0.0001, respectively). On multivariate analysis, mature teratomas located in the pineal, and those having undergone subtotal resection (STR) demonstrated high mean OS (p = 0.0023 and p = 0.0044, respectively). Mature and mixed/malignant suprasellar teratomas had equally higher mean OS versus immature suprasellar teratomas (p < 0.0001). Mature and immature teratomas treated with adjuvant therapy had significantly higher mean OS compared to those managed with surgery alone (p = 0.0421 and p = 0.0423, respectively). Males with immature teratomas had the highest mean OS (p < 0.0001). Immature teratomas managed with surgery alone had higher mean DFS, but lower mean OS, compared to those treated with adjuvant therapy (p = 0.0176 and p = 0.0423, respectively).

Conclusions: Our data highlight the divergent nature of the different histopathological subtypes of teratomas, and suggest that survival outcomes are multifactorial. Specifically, male sex, pineal, suprasellar, GTR, and STR were dependent predictors of OS, while histopathology was an independent predictor of OS.

Keywords: Intracranial; Outcomes; Pathology; Teratoma.

Publication types

Meta-Analysis

MeSH terms

Brain Neoplasms* / mortality
Brain Neoplasms* / pathology
Brain Neoplasms* / therapy
Female
Humans
Male
Teratoma* / mortality
Teratoma* / pathology
Teratoma* / therapy