Prognostic Factors and Nomogram for Choroid Plexus Tumors: A Population-Based Retrospective Surveillance, Epidemiology, and End Results Database Analysis

Background: Choroid plexus tumors (CPTs) are rare neoplasms found in the central nervous system, comprising 1% of all brain tumors. These tumors include choroid plexus papilloma (CPP), atypical choroid plexus papilloma (aCPP), and choroid plexus carcinoma (CPC). Although gross total resection for choroid plexus papillomas (CPP) is associated with long term survival, there is a scarcity of prospective data concerning the role and sequence of neoadjuvant therapy in treating aCPP and CPC.

Methods: From the years 2000 to 2019, a total of 679 patients with CPT were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Among these patients, 456 patients had CPP, 75 patients had aCPP, and 142 patients had CPC. Univariate and multivariable Cox proportional hazard models were run to identify variables that had a significant impact on the primary endpoint of overall survival (OS). A predictive nomogram was built for patients with CPC to predict 5-year and 10-year survival probability.

Results: Histology was a significant predictor of OS, with 5-year OS rates of 90, 79, and 61% for CPP, aCPP, and CPC, respectively. Male sex, older age, and African American race were prognostic for worse OS for patients with CPP. Overall, treatment with gross total resection or subtotal resection had no difference on the OS in patients with CPP. Meanwhile, treatment with gross total resection was associated with significantly better OS than subtotal resection in patients with CPC. For patients who received subtotal resection, the receipt of adjuvant therapy in addition to the subtotal resection showed no difference between OS when compared to patients who received gross total resection. Adjuvant therapy plays a critical role in survival, especially in patients who receive subtotal resection. The nomogram for CPC included types of treatments received. It demonstrated acceptable accuracy in estimating the survival probability at 5- and 10-year intervals, with C index of 0.608 (95% CI of 0.446–0.77).

Conclusions: The study demonstrates the survival difference between patients with CPP compared to patients with CPC. It highlights some of the optimum treatment options available for treatment of both CPP and CPC. This study also illustrates the survival benefit of adjuvant therapy with chemotherapy and radiation in the treatment of CPTs. Especially, in patients with CPC that receive subtotal resection, the use of any adjuvant therapy can significantly improve OS.

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Artikel online veröffentlicht:
05. Februar 2024