| Objective:Based on the SEER database of the National Cancer Institute,the clinical characteristics,overall survival rate and prognostic factors of children and adults with medulloblastoma were analyzed and compared,and a clinical prognostic prediction model was constructed.Methods:The clinical data of 1227 patients diagnosed with medulloblastoma from 2004 to2015 in the SEER database were collected and organized,including 867 children(age<18 years)and 360 adult(age ≥18 years).First,we used the Kaplan-Meier function to plot the survival curves of children and adults,and used the Log-rank method to compare the differences between the two groups.Then,we used the Kaplan-Meier function to plot the survival curves of each clinical factor and children and adults.Next,we used univariate and multivariate COX regression analysis to evaluate the relationship between each clinical factor and patient prognosis,and the corresponding hazard ratio with 95% confidence interval predicted the impact of each clinical factor on prognosis.Finally,we included these prognostic factors into the construction of nomograms for children and adults respectively and used Bootstrap self-sampling method for internal validation,and assessed the accuracy of nomograms by concordance index(C-index)and calibration curve.Results:1.A total of 1227 patients with medulloblastoma,including 867 children and360 adults.The median age of onset of medulloblastoma in children is about 6 years old,and the peak incidence is 0 to 10 years old;the median age of onset of adult medulloblastoma is about 29 years old,and the peak incidence is 18 to 40 years old.Medulloblastoma is more common in males,about 62.05% of children are males,and about 58.33% of adults are males.About 82.47% of the pediatric patients and 85.28%of the adult patients were Caucasian.Medulloblastoma is more common in the cerebellum,of which about 76.93% of pediatric patients are cerebellar medulloblastoma,and about 89.44% of adult patients are cerebellar medulloblastoma.The tumor diameter of children patients was 2～450mm,and the average tumor diameter was about 43.61 mm.In adult patients,the tumor diameter ranged from 5 mm to 127 mm,with an average tumor diameter of 39.67 mm.The classic medulloblastoma in children was about 81.55%.The classic medulloblastoma of adult patients is about80.28%.2.In the included patients,until the end of follow-up,253 children died and 100 adults died.The 3,5,and 10-year overall survival rates of children were 79.1%,74.2%,and 67.7%,and the 3,5,and 10-year overall survival rates of adult patients were 84.0%,77.0%,and 68.6%.There was no statistical difference between the two groups(P>0.05).The 3,5,and 10-year overall survival rates for children aged 0～3years were 68.5%,65.5%,and 61.5%,for children older than 3 years,the 3,5,and10-year overall survival rates were 82.9%,77.4%,and 69.9%,the overall survival rate between the two groups was statistically different(P<0.05).The 3,5,and 10-year overall survival rates for adults aged 18～30 were 84.8%,78.3%,and 74.2%,and the 3,5-,and 10-year overall survival rates for adults older than 30 were 83.1%,75.4%,and63.4%,there was no statistical difference in the overall survival rate between the two groups(P>0.05).3.Univariate COX regression analysis showed that age,histological type,surgical method,radiotherapy and chemotherapy were closely related to the prognosis of children,and radiotherapy and chemotherapy were closely related to the prognosis of adults.Multivariate COX regression analysis showed that age,histological type,surgical method,radiotherapy and chemotherapy were independent prognostic factors in children,and radiotherapy was an independent prognostic factor in adults.4.According to the results of COX regression analysis,age,histological type,surgical method,radiotherapy and chemotherapy were included to construct a nomogram for children,and radiotherapy and chemotherapy were included to construct a nomogram for adult patients.The two groups of nomograms can better predict the prognosis of children and adults.The C-index is 0.67 and 0.61,respectively.The constructed nomogram can better predict the prognosis of children and adults,with C-index of 0.67 and 0.61,respectively.The calibration curve of the model shows that the survival rate predicted by the nomogram is close to the actual survival rate.Conclusion:1.The median age of onset in children with medulloblastoma is about 6 years old,with a peak incidence of 0 to 10 years old;the median age of onset of adult medulloblastoma patients is about 29 years old,with a peak incidence of 18 to 40 years old.2.Both children and adults with medulloblastoma are more common in males,and are more common in the cerebellum.The histological type is mostly classic.3.Children and adults with medulloblastoma have similar overall survival rates,and there are significant differences in overall survival rates among children in different age groups,but this feature is not obvious in adults.4.Among the clinical factors included,age,histological type,surgical method,radiotherapy,and chemotherapy were independent prognostic factors in children with medulloblastoma;only radiotherapy was an independent prognostic factor in adults with medulloblastoma.5.The nomogram constructed in this study can better predict the overall survival rate of children and adults with medulloblastoma,and provide a theoretical basis for individualized diagnosis and treatment and prognosis judgment. |
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