Purpose To investigate the predictor factors of mortality describing the prognosis of primary surgical resection of low-grade astrocytoma. Materials and methods A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to November 14, 2021. All statistical analysis was conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result were reported in the hazards ratio (HR) and corresponding 95% confidence interval. Result Five cohort studies were selected for meta-analysis. There was statistically significant effect of total resection on increase mortality after surgery in low-grade astrocytoma patients (HR = 0.70 [0.52, 0.94]; p = 0.02; I2 = Not applicable). On the other hand, there was statistically nonsignificant effect of patient’s age (HR = 1.27 [0.95, 1.68]; p = 0.11; I2 = 83%), tumor size (HR = 1.13 [0.94, 1.35]; p = 0.19; I2 = 73%), and increasing KPS (HR = 0.59 [0.20, 1.77]; p = 0.35; I2 = 86%) on prognosis of low-grade astrocytoma after surgery. Conclusion The results of meta-analysis showed significant relationship of extent of resection and mortality, while factors such age, KPS score, and tumor size were nonsignificant to determine mortality in patient diagnosed with low-grade astrocytoma. The gross total resection surgery should be preferred over subtotal resection since the incidence of malignant formation is low in gross total resection.
The pilomyxoid astrocytoma (PMA) is a rare glioma that has recently been identified as a separate entity and is frequently found in the hypothalamic region. PMA is a subtype of pilocytic astrocytoma (PA), with clinical, histological, and molecular data indicating a close relationship as well as more aggressive biological behaviour in the former. There is still doubt in surgical outcome of PMA that the extent of resection, independent of location or age, is a key factor of recurrence and subsequent therapeutic choices. However, further study is needed to better understand its behaviour and, as a result, establish a consensus on its management. This research features a 2-year-6-month-old female who sought medical attention after complaining of weight loss for four weeks and vomiting for two weeks prior to her visit to the doctor. She had no additional symptoms. Only bilateral pailledema was found during the physical examination. The magnetic resonance imaging (MRI) scans revealed a tumor in the sellar area with heterogeneous enhancement. The patient had ventriculoperitoneal (VP) shunting followed by partial tumor excision twice (Extent of resection 35 percent followed by 16 percent as total 51 percent). The histology and immunohistochemical investigations revealed typical PMA characteristics. Adjuvant treatment, which included chemotherapy and radiosurgery, was initiated for the patient. She has been asymptomatic for two years and has showed no indications of progression of the disease on follow-up scans.
The authors present a 3-year-old female with increasing proptosis and absent vision in the right eye. Chemotherapy had done for 3months. But her ailments lingered. The right eye exhibited severe proptosis and poor vision, whereas the left eye was normal with 20/20 vision. Preoperative MRI revealed a dumbbell-shaped tumor in the intra-orbital and intra-cranial section of the right optic nerve. A lateral supra-orbital approach was used to dissect the dumbbell-shaped tumor and the right optic nerve. No remnant of the tumor was discovered during a follow-up examination. The case study demonstrates how to identify and treat ONA surgically. However, we need further research on optic nerve PA to gain a better understanding of their behavior. While gross total resection (GTR) is usually curative, tumors in deep locations may be unresectable and require alternative therapeutic procedures. Additionally, the case study emphasizes the importance of additional research on early detection and prevention.
Актуальність. Піковий вік розвитку пілоцитарної астроцитоми (ПА), різновиду доброякісної пухлини мозочка, припадає на вік від 10 до 20 років. Пухлина, відома як пілоцитарна астроцитома в дорослих, зустрічається надзвичайно рідко. Отже, дуже мало відомо про характеристики цих пухлин. Матеріали та методи. Ми ретроспективно проаналізували дані пацієнтів віком від 18 років із патологічно підтвердженою пілоцитарною астроцитомою, які перенесли операцію з видалення пухлини між січнем 2010 року й січнем 2020 року та перебували під наглядом до січня 2022 року. Результати. Хоча спочатку 32 випадки були позначені як ПА, у дослідження включили лише 4 пацієнтів (2 чоловіки і 2 жінки) з пілоцитарною астроцитомою, яким у середньому було 26,75 року. Середній вік чоловіків на момент встановлення діагнозу дорівнював 28 рокам, смертності чи рецидивів у цій групі не зафіксовано. Середній вік пацієнток на момент встановлення діагнозу був 25 років. Після закінчення періоду спостереження одна жінка була живою. Причина смерті другої пацієнтки не пов’язана з пухлиною. Середній термін спостереження за жінками становив 36 місяців, а середня загальна виживаність — 42 місяці. Висновки. Пілоцитарна астроцитома в дорослих розвивається інакше, ніж у дітей. Показано, що обсяг хірургічної резекції та розташування пухлини впливають на прогноз. Якщо можливо, тотальна резекція має бути основним типом лікування. Спостерігаються хороші показники виживаності та нечасті рецидиви.
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