Original ArticleLong-Term Outcome and Prognostic Factors After Repeated Surgeries for Intracranial Hemangiopericytomas
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.
References (24)
- et al.
Intracranial hemangiopericytoma: radiology, surgery, radiotherapy, and outcome in 21 patients
Surg Neurol
(1985) - et al.
Multimodal treatment and management strategies for intracranial hemangiopericytoma
J Clin Neurosci
(2015) - et al.
Surgical management and adverse factors for recurrence and long-term survival in hemangiopericytoma patients
World Neurosurg
(2017) - et al.
Analysis of prognostic factors, survival rates and treatment in anaplastic hemangiopericytoma
World Neurosurg
(2017) - et al.
Management of recurrent intracranial hemangiopericytoma
J Clin Neurosci
(2011) - et al.
Hemangiopericytoma of the central nervous system: a review of 94 cases
Hum Pathol
(1991) - et al.
Primary intracranial haemangiopericytoma: comparison of survival outcomes and metastatic potential in WHO grade II and III variants
J Clin Neurosci
(2014) - et al.
Intracranial hemangiopericytoma–our experience in 30 years: a series of 43 cases and review of the literature
World Neurosurg
(2014) - et al.
Hemangiopericytoma: a vascular tumor featuring Zimmermann's pericytes
Ann Surg
(1942) - et al.
Meningeal hemangiopericytoma: histopathological features, treatment, and long-term follow-up of 44 cases
Neurosurgery
(1989)
Invasiveness is associated with metastasis and decreased survival in hemangiopericytoma of the central nervous system
J Neurooncol
Intracranial meningeal hemangiopericytoma: Recurrences at the initial and distant intracranial sites and extraneural metastases to multiple organs
Mol Clin Oncol
Cited by (5)
Nervous System Hemangiopericytoma
2020, Canadian Journal of Neurological SciencesSkull base hemangiopericytomas
2022, Acta Neurologica Belgica
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.