Second surgery and the prognosis of choroid plexus carcinoma - Results of a meta-analysis of individual cases

Tumors of the choroid plexus (CPT) are rare. While choroid plexus papillomas (CPP) are regarded as benign, choroid plexus carcinomas (CPC) have a dismal prognosis, and there is limited information available regarding the best treatment. Maximal possible surgery is generally believed to be the major prognostic factor, but data to answer the question, of whether second surgery improves the prognosis of CPC have been missing. A database of all cases of CPT reported in the literature until 2004 was created to determine prognostic factors and analyze therapeutic modalities. Eight hundred and fifty-seven cases of CPT were identified. Three hundred and forty-seven patients had CPC, 15 atypical choroid plexus papillomas (APP) and 495 CPP. Besides histology, complete resection was confirmed to be the most important prognostic factor in each of the subgroups defined by the three histological diagnoses. In CPP, complete resection was more frequently achieved (80.4%) than in APP (61.5%) or CPC (39.6%). Among the subgroup of incompletely resected CPC, 22.6% of the patients had second surgery. The prognosis of these patients appeared better when compared to incompletely resected CPC without second surgery (2-year overall survival 69% versus 30%). There was no such difference within the subgroup of CPP. This study suggests, if complete resection is not possible in the first surgery of a choroid plexus carcinoma, a second resection should be considered.