Elsevier

World Neurosurgery

Volume 107, November 2017, Pages 495-505
World Neurosurgery

Original Article
Long-Term Outcome and Prognostic Factors After Repeated Surgeries for Intracranial Hemangiopericytomas

https://doi.org/10.1016/j.wneu.2017.08.027Get rights and content

Objective

The goals of the present study were to identify predictors of better survival and to propose appropriate management strategies for recurrent hemangiopericytomas (HPC) and anaplastic hemangiopericytomas (AHPC).

Methods

Between 2008 and 2016, 191 patients underwent surgeries for HPC and/or AHPC at our institute, and during follow-up the tumors recurred in 57 patients, including 31 males (54.4%).

Results

At the first recurrence, 30 patients (52.6%) underwent surgery, 25 patients (43.9%) declined surgery, and 2 patients (3.5%) received Gamma Knife treatment. The 1-year, 3-year, and 5-year actuarial rates of second progression-free survival in the HPC group were 73.3%, 46.7%, and 24.9%, respectively; the rates in the AHPC group were 66.7%, 66.7%, and 0%, respectively. The actuarial 1-year, 3-year, and 5-year overall survival rates of HPC after the first recurrence were 87.4%, 69.2%, and 39.5%, respectively; in the AHPC group, the rates were 85.2%, 45.9%, and 24.5%, respectively. Each 1-month increase in the time interval from first surgery to first recurrence (first recurrence-free survival) (hazard ratio, 0.972; 95% confidence interval, 0.952–0.993; P = 0.010) was strongly associated with better overall survival. Patients who received surgery with or without radiation at their first recurrence survived longer than patients who did not (estimated median survival time, 53.0 months vs. 35.7 months; P = 0.028).

Conclusions

Treatment is imperative for the first recurrence of HPC or AHPC. More attention should be paid to patients with shorter first recurrence-free survival. Surgery is the first choice for their first recurrence and radiotherapy should be administered if there is no history of radiotherapy.

Introduction

Hemangiopericytoma (HPC), first reported by Stout and Marray in 1942,1 is a highly vascular neoplasm believed to be derived from pericytes around capillaries and postcapillary venules. Intracranial HPC, an uncommon condition that accounts for less than 1% of all intracranial tumors, has a strong propensity to recur and to metastasize at distant sites. HPC and anaplastic HPC (AHPC) are recognized for their high recurrence rate even after gross total resection (GTR)2, 3; poor progression-free survival (PFS) even after initial aggressive management remains a generally important concern for both conditions.

Some previously reported studies have increased our understanding of disease progression and overall survival (OS) in patients with HPC or AHPC; however, there is a paucity of research regarding prognostic factors and survival with these recurrent tumors. The goals of the present study were to identify predictors of better survival and to propose appropriate management strategies for recurrent tumors.

Section snippets

Patient Population

Between December 2008 and January 2016, a consecutive cohort of 191 patients underwent HPC or AHPC surgery at Beijing Tiantan Hospital. Tumors recurred in 60 patients (31.4%), and 3 patients were lost to the final follow-up. We included 57 patients with recurrent HPC or AHPC for further analysis. Patients who underwent primary surgery at other hospitals and secondary surgery at our hospital were included because their clinical information was available. In the AHPC group, AHPC patients were

Patient Demographics

Between 2008 and 2016, 191 patients underwent surgical treatment at our hospital. Recurrent HPC (grade II) and AHPC (grade III) were identified in 60 (31.4%) of these patients. Fifty-seven patients showed histologic findings of HPC (n = 35) or AHPC (n = 22) and were included in this retrospective study. Thirty-one (54.4%) patients were male, and 26 (45.6%) were female. Nineteen patients (7 cases of AHPC and 12 cases of HPC) received PRT after the initial surgery, and of these 19 patients, 13

Discussion

Some previous studies have reported on treatments and other factors that are associated with favorable outcomes for patients with HPC or AHPC.5, 6, 7 However, because of the relative infrequency of recurrent HPC and AHPC tumors, little has been published regarding clinical information and outcomes after first recurrence.4, 8, 9 Intracranial HPC and AHPC are recognized to have a high recurrence rate of 34%–91%4, 7, 8, 10 and a high metastasis rate of 13%-64%.2, 4, 7, 8 It is difficult for

Conclusions

We reported a large cohort of recurrent HPC and AHPC tumors to increase the understanding of these tumors with respect to predicting survival and selecting treatments. Some potential risk factors were associated with worse survival. It is important to focus on patients with a shorter interval to recurrence and patients who did not undergo treatment at their first recurrence. In subgroups, patients with HPC and AHPC who have undergone GTR have better survival.

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  • Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

    Wei Wang and Gui-Jun Zhang contributed equally to this work.

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