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. 2024 Jul 2:15:1386121.
doi: 10.3389/fneur.2024.1386121. eCollection 2024.

Pediatric WNT medulloblastoma predisposition in intraoperative blood loss: a retrospective observational cohort study

Zaiyu Zhang  1   2   3   4 , Yuxin Wu  1   2   3   4 , Xueling Zhao  1   2   3   4 , Wenyuan Ji  1   2   3   4 , Lusheng Li  1   2   3   4 , Xuan Zhai  1   2   3   4 , Ping Liang  1   2   3   4 , Yuan Cheng  5 , Jianjun Zhou  1   2   3   4
Affiliations

Pediatric WNT medulloblastoma predisposition in intraoperative blood loss: a retrospective observational cohort study

Zaiyu Zhang et al. Front Neurol. .

Abstract

Introduction: Molecular subgroups influence the vascular architecture within medulloblastomas, particularly the wingless (WNT) subgroup, which contributes to its propensity for primary tumor hemorrhage. Whether this mechanism affects intraoperative blood loss remains unknown. This study aimed to assess the association between WNT medulloblastoma and the predisposition for blood loss.

Methods: This was a retrospective observational study using data from a neuro-oncology center comprising molecular data on patients treated between December 31, 2014, and April 30, 2023. Differences between WNT and other subgroups in the risk of primary outcome-intraoperative blood loss were assessed using multivariable-adjusted linear regression.

Results: Of the 148 patients included in the analysis, 18 patients (12.2%) had WNT, 42 (28.4%) had sonic hedgehog (SHH) TP53-wildtype, 7 (4.7%) had SHH TP53-mutant, and 81 (54.7%) were non-WNT/ non-SHH. The WNT subgroup more frequently underwent primary intratumoral hemorrhage (22% vs. 3.8%; p = 0.011). The median intraoperative blood loss was 400.00 (interquartile range [IQR] 250, 500) mL for WNT and 300.00 [200, 400] mL for the other subgroups (p = 0.136), with an adjusted β of 135.264 (95% confidence intervals [CI], 11.701-258.827; p = 0.032). Similar results were observed in both midline and noninfiltrative margin medulloblastoma.

Discussion: WNT medulloblastoma is typically associated with primary intratumoral hemorrhage and intraoperative blood loss. The validity of determining the surgical approach based on predicted molecular subtypes from imaging data is questionable. However, attempting to engage in risk communication with patients in a molecular-specific way is worthwhile to validate.

Keywords: blood loss; hemorrhage; medulloblastoma; molecular subgroup; wingless.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Consort diagram of the study population. SHH, sonic hedgehog; WNT, wingless.
Figure 2
Figure 2
(A) Rates of primary intratumoral hemorrhage and (B) volume of intraoperative blood loss. SHH, sonic hedgehog; WNT, wingless.
See this image and copyright information in PMC

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