Pediatric Brainstem Gliomas: A Retrospective Study of 180 Patients from the SEER Database

Abstract

Background/Aims: Large population-based studies are needed to assess the epidemiology and survival risk factors associated with pediatric brainstem gliomas. This retrospective study explores factors that may influence survival in this population. Methods: Utilizing the SEER database, the authors retrospectively assessed survival in histologically confirmed brainstem gliomas in patients aged 17 and younger. Survival was described with Kaplan-Meyer curves and multivariate regression analysis. Results: This analysis of 180 cases showed that age (hazard ratio [HR] 1.04, 95% CI 0.96–1.14, p = 0.34), non-white race (HR 1.00, 95% CI 0.35–2.85 p > 0.99), distant or invasive extension of the tumor (HR 0.4, 95% CI 0.08–2.53, p = 0.37), and radiation therapy (HR 1.27, 95% CI 0.52–3.11, p = 0.61) were not associated with decreased survival. High-grade tumor status (HR 8.64, 95% CI 3.49–21.41, p < 0.001) was associated with decreased survival. Partial resection (HR 0.11, 95% CI 0.04–0.30, p < 0.001) and gross-total resection (HR 0.03, 95% CI 0.01–0.14, p < 0.001) were associated with improved survival. Conclusions: High-grade brainstem gliomas have a worse prognosis. Early diagnosis and surgery appear to be associated with improved survival, while the role of radiation is unclear.

Current clinical practice about pediatric midline gliomas in the scope of molecular era

“…Patients with these tumors present with motor or sensory deficits, psychological symptoms, hydrocephalus and, rarely, seizures (24). In our series, the patients' presenting symptoms were headache, disequilibrium, ophthalmoplegia, dizziness, panic attack and absence seizures (16). Since sur-Immunohistochemical pathology results were consistent with grade 2 diffuse astrocytoma in 8 (50%) patients, and high grade diffuse glioma in 8 (50%) patients.…”

“…Deep seated midline gliomas originating from the brainstem constitute 10% of all primary brain tumors in the pediatric age group (16). The incidence of pediatric gliomas originating from the thalamus ranges between 1%-5% (2).…”

“…of less than 1 year (16). Advancements in tumor molecular biology research has led to targeted treatment strategies and some exciting clinical trials for DMGs (4,19,29,31).…”

The Epidemiological Characteristics and Prognostic Factors of Low-Grade Brainstem Glioma: A Real-World Study of Pediatric and Adult Patients

“…Diffuse brainstem pontine glioma (DIPG) is associated with dismal prognosis in both pediatric and adult patients, being highly infiltrative and less amenable to surgery (4,5). Pathologically, pediatric and adult patients with highgrade BSG (HGBSG), including World Health Organization (WHO) grades III and IV BSG, have worse clinical outcomes (6,7). Over the last two decades, we have gained deep understanding on pediatric DIPG and HGBSG in terms of biological characteristics, prognostic factors, and treatment strategies (8)(9)(10)(11).…”

A Constructed and Validated Nomogram for Preoperatively Predicting Cancer-specific Survival Rates in Pediatric Patients with Brainstem Malignant Gliomas: A SEER-based Study

“…Previously, studies have shown that malignant brainstem gliomas in pediatric patients have a poor prognosis. [10,11] Therefore, there is a need to discover a new complete prognostic scoring system for an accurate and useful prognosis assessment. A nomogram is a graphical representation of complex mathematical formulas.…”