- Department of Neurosurgery, University of Athens, Evangelismos Hospital, Athens, Greece
- Hellenic Center of Neurosurgical Research (HCNR), “Professor Petros S. Kokkalis”, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Center for Health Services Research, University of Athens, Athens, Greece
- Department of Pathology, Evangelismos Hospital, Athens, Greece
Correspondence Address:
Theodosis Kalamatianos
Department of Neurosurgery, University of Athens, Evangelismos Hospital, Athens, Greece
Hellenic Center of Neurosurgical Research (HCNR), “Professor Petros S. Kokkalis”, Athens, Greece
DOI:10.4103/2152-7806.107893
Copyright: © 2013 Stranjalis G This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.How to cite this article: Stranjalis G, Kalamatianos T, Stavrinou LC, Mathios D, Koutsarnakis C, Tzavara C, Loufardaki M, Protopappa D, Argyrakos T, Rontogianni DP, Sakas DE. The Evangelismos hospital central nervous system tumor registry: Analysis of 1414 cases (1998-2009). Surg Neurol Int 27-Feb-2013;4:23
How to cite this URL: Stranjalis G, Kalamatianos T, Stavrinou LC, Mathios D, Koutsarnakis C, Tzavara C, Loufardaki M, Protopappa D, Argyrakos T, Rontogianni DP, Sakas DE. The Evangelismos hospital central nervous system tumor registry: Analysis of 1414 cases (1998-2009). Surg Neurol Int 27-Feb-2013;4:23. Available from: http://sni.wpengine.com/surgicalint_articles/the-evangelismos-hospital-central-nervous-system-tumor-registry-analysis-of-1414-cases-1998-2009/
Abstract
Background:The Evangelismos Hospital central nervous system (CNS) Tumor Registry represents the current effort of the Departments of Neurosurgery and Pathology to collect data for primary and metastatic CNS tumor patients. In the present study, 12-year hospital data (1998-2009) were reviewed and analyzed.
Methods:Patients that underwent surgery for CNS tumors for the first time were identified. Histologically confirmed tumor rates by age and gender were compared. Time trends in annual rates for specific tumor types were investigated. In-hospital mortality rates and length of hospital stay were analyzed by age and gender and their putative variations across the study period investigated.
Results:A total of 1414 patients (age 15-89 years) were identified. The most frequently encountered histologies were gliomas and meningiomas, accounting for, respectively, 32.8% and 29.1% of the total sample. A greater proportion of meningiomas was found in women; the proportion of glioblastomas and metastatic tumors, as well as of mixed gliomas, were greater in men. Increased rates of glioblastoma and meningioma with advancing age at diagnosis were also apparent. There were no significant variations in time trends for specific tumor types. In-hospital mortality was significantly higher for older patients (≥70 years). An increase in the length of hospital stay was apparent between the first and middle third of the study period.
Conclusions:Analysis of tumor rates in relation to age at diagnosis and gender showed significant bias in accordance with salient literature. Available data indicated no significant variations in time trends for specific tumor types across the study period, while an adverse effect of advanced age on in-hospital mortality was shown. The present findings can guide the formulation of future treatment programs and preventive strategies and provide the basis for further intra- and/or interdepartmental research.
Keywords: Central nervous system tumors, hospital-based tumor registry, length of hospital stay, mortality, surgical mortality
INTRODUCTION
Central nervous system (CNS) tumors comprise a highly complex, heterogeneous group of neoplasms exhibiting great diversity in histological traits, patterns of growth, recurrence, and treatment response.[
Given that a national registry on CNS tumors in Greece has not yet been established, epidemiological analysis on this clinical entity remains a significant challenge. Toward this direction, the Departments of Neurosurgery and Pathology at Evangelismos Hospital, the largest general hospital in Greece,[
MATERIALS AND METHODS
This study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.
Data collection and tumor classification/staging
The Evangelismos Hospital CNS Tumor Registry (ECTR) represents the current effort of the Departments of Neurosurgery and Pathology to collect data in an electronic format for all primary and metastatic CNS tumor patients from 1998 onwards. Data drawn from the respective departmental databases incorporating patient demographic characteristics, tumor histological types, and surgical outcome are combined within a single database. Tumor classification data are based on International Classification of Diseases for Oncology (ICD-O) histology, as described previously.[
Statistical analysis
Continuous variables are presented with mean and standard deviation (SD) and/or median (interquartile range = IQR). Qualitative variables are presented with absolute and relative frequencies. Chi-square tests for homogeneity were used to evaluate differences in tumors rates over the years. P values for trends in tumors rates over the ordered categories of age groups were also computed. For in-hospital mortality, Pearson's Chi-square tests were also used to evaluate differences in proportions between men and women, age groups and time periods. Mann-Whitney tests were used for the comparison of hospital stay between two groups. For the comparison of in-hospital mortality rates between all different tumors categories, Bonferroni correction for the control of type I error was implied and only differences with P values less than 0.001 are presented. All P values reported are two-tailed. Statistical significance was set at 0.05 and analyses were conducted using SPSS statistical software (version 17.0).
RESULTS
Patient demographic characteristics
A total of 1414 patients (49.7% men and 50.3% women) with a mean age of 55.4 years (SD = 14.4 years) were identified over the 12-year study period (1998-2009). Thirteen patients between the age of 15 and 18 years (13/1414, 0.9%), treated in our department were incorporated in the present analysis. The majority of patients (51.3%) aged between 52 and 70 years; 26.9% of patients aged between 33 and 51 years while 7.6% of patients aged less than 33 years. Among those, 1351 patients (95.5%) had newly diagnosed, histologically confirmed tumors while 63 patients (4.5%) remained undiagnosed due to failure of biopsy procedures. Intracranial localization of tumors was evident in the vast majority of cases (93%, n = 1315); a small proportion (7%, n = 99) showing spinal origin. All patients underwent either a craniotomy or laminectomy for total or partial tumor excision or diagnostic biopsy.
Histological findings and annual incidence rates
The relative frequencies of the major histological categories in the ECTR are shown in
Figure 2
Linear histogram depicting the annual percentage of patients diagnosed with four of the common tumor types identified in our registry namely glioblastomas, other gliomas (including oligoastrocytomas and other non WHO grade IV astrocytic tumors), meningiomas and metastases that were hospitalized in the neurosurgery clinic of Evangelismos hospital between 1998 and 2009
In-hospital mortality rates and hospitalization time
The median number of hospital days for total sample was 16 (IQR: 11-25). There was a significant increase (P < 0.001) of hospital stay from 1998-2001 (median = 15 days, IQR 11-23) to 2002-2005 (median = 18 days, IQR 12-27). Hospitalization time did not vary significantly from 2002-2005 to 2006-2009 (median = 17 days, IQR 11-26). There was no age (70 years cut-off) or gender-related differences in hospitalization time. In-hospital mortality rates did not vary significantly between the three consecutive 4-year periods.
DISCUSSION
The Departments of Neurosurgery and Pathology at Evangelismos Hospital are committed to the generation and maintenance of an electronic CNS tumor registry (ECTR that allows for the evaluation of health-care provision, the analysis of health trends, and formulation of future treatment programs and preventive strategies). In the present study, we analyzed our 12-year data, incorporating a total of 1414 patients (age 15-83 years) that were treated for CNS tumors for the first time. To our knowledge this is the first report on data incorporating all major tumor types from a large series of patients in Greece. A previous study has provided population-based data on cerebral gliomas in a defined Northwest area of Greece,[
The present findings indicated that meningiomas and glioblastomas were the most frequently encountered primary CNS tumors, accounting for, respectively, 29,1% (n = 412) and 16.3% (n = 231), followed by nerve sheath tumors (n = 92, 6.5%) and adenomas (n = 88, 6.2%). The relatively low percentage of metastases (n = 157, 11%) and lymphomas (n = 23, 1.6%) in our series may be due to the exclusion of cases that are considered inoperable and thus treated solely with chemotherapy or radiation. As a corollary, higher rates for metastases and lymphomas are typically reported in neurooncology series.[
Our analysis of tumor rates by age and gender indicated significant bias. The present findings of significantly higher rates for meningiomas in women, a male predominance for glioblastomas, and increases in the incidence rates for glioblastoma and meningioma with advancing age at diagnosis, are consistent with the preponderance of evidence provided by salient epidemiological studies and reports.[
Given changing trends in diagnostic technique and tumor classification, analyses of time trends in the incidence of histologically defined tumors remains a significant challenge.[
In-hospital mortality was another parameter analyzed in the present study. Our results indicated an overall in-hospital mortality rate of 5.4% (ranging between 1.1% for nerve sheath tumors and 8.7% for lymphomas). The in-hospital mortality for brain tumor patients was 5.8%. The Department of Neurosurgery[
Examining the impact of age on in-hospital mortality rates, the present findings indicated significantly higher mortality rates for older patients (70 years cut-off point). This finding appears consistent with previous evidence indicating that advanced age has an adverse effects on neurosurgical mortality rates in tumor patients.[
CONCLUSIONS
This is the first report on data incorporating all major CNS tumor types from a large cohort of patients (N = 1414, age 15-83 years), in Greece. Analysis of histologically characterized tumors in relation to age at diagnosis and gender showed significant bias in accordance with salient literature. Available data indicated no significant variations in time trends for specific tumor types across the 12-year study period, while an adverse effect of advanced age (≥70 years) on in-hospital mortality was shown. Data on hospital stay indicated relatively long hospitalization times and an increase in the length of hospital stay between the first and middle third of the study period. The present finding can guide the formulation of future treatment programs and preventive strategies and provide the basis for intra- and/or interdepartmental research.
We would strongly encourage other neurosurgical centers to foster interdepartmental collaborations in order to collect, analyze, and publish equivalent data that could form the basis for a future national population-based registry. In this regard, it is noteworthy that CNS tumor population incidence rates for Greece are currently estimated on the basis of the national mortality for 2008 by means of modeling, using a set of age, sex, and site-specific incidence mortality ratios obtained by the aggregation of recorded cancer registry data from the cancer registries of neighboring countries.[
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