Pediatric Intracranial Germ Cell Tumors with Tumoral Hemorrhage: The Clinical Prognosis and Evaluation of Medical Cost

• Main Authors: CHEN, JU-TING, 陳儒廷
• Other Authors: CHEN, CHI-CHEN
• Format: Others
• Language: en_US
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/7u33j6

碩士 === 輔仁大學 === 公共衛生學系碩士班 === 105 === Background. The intracranial germ cell tumors (GCTs) are known as more common in the East-Asian than the Western countries. Although some types of GCTs have high tumoral hemorrhage rate and poor outcomes, the influence of pediatric intracranial GCTs associated with tumor hemorrhage on their outcomes were not clarified. We know pediatric brain tumor is difficult and expensive to treat, but no literature evaluated the medical costs of pediatric GCTs and the effect of tumoral hemorrhage on medical costs. This study aimed to evaluate survival, clinical outcomes and medical costs of pediatric intracranial GCTs with tumoral hemorrhage. Purposes. The purposes of this retrospective cohort study include two parts: (1) examing the effect of tumoral hemorrhage on survival and clinical prognosis (2) investigating the per-patient cost of pediatric patients with intracranial GCTs and cost-effectiveness analysis. Methods. Between 2001 and 2016, there were 17 pediatric patients diagnosed with intracranial GCT associated with tumoral hemorrhage as their initial presentation in study hospital. GCT patients without hemorrhage was selected as control group by matching the same age and gender in ratio of 1:2. We reviewed the clinical and MRI findings to find out the correlation between the tumoral hemorrhage and survival and clinical functional outcomes. The modified Rankin Scale (mRS) was used for assessment of clinical functional outcome. Medical cost was estimated according to the medical records. Results. Significantly worse survival outcomes in the patients with tumoral hemorrhage was found (HR=18; p=0.004). The results of Cox regression showed patients with tumoral hemorrhage were about fifteen times more likely to get long-term poor survival outcome (HR=15.3; p=0.04). Patients with tumoral hemorrhage were about seven times more likely to get long-term poor clinical outcome(mRS≧3) (HR=7.17; p=0.04). The per-patient cost of patient with GCTs was NTD 985,771. The per-patient cost of patient with tumoral hemorrhage was significantly more than patients without tumoral hemorrhage (NTD 1,406,659 v.s. NTD 775,327, p=0.001). The incremental cost-effectiveness ratio (ICER) in our study was NTD -21577. The tumoral hemorrhage group cost more money but had less survival months. Conclusion. Our study demonstrated that GCTs patients with tumoral hemorrhage had significantly worse survival and clinical functional outcomes and more per-patient cost. We suggest performing early and aggressive treatment for the pediatric patients of intracranial GCTs with tumoral hemorrhage to improve the prognosis. Adding some anti-angiogenic therapies for those GCTs with hemorrhage might be helpful, but need more further research to prove. This might help improve quality of life and health outcomes for these children and their families.