Survival and Prognosis of Patients with Pilocytic Astrocytoma: A Single-Center Study
Jae Hui Park1, Nani Jung1, Seok Jin Kang1
1Department of Pediatrics, Keimyung University School of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
Insights
Pilocytic astrocytoma (PA) survival depends on surgical resection extent. Gross total resection (GTR) significantly improves progression-free survival (PFS), while disease-specific survival (DSS) is less affected by GTR or additional treatments.
Area of Science:
- Neuro-oncology
- Pediatric neurosurgery
- Cancer research
Background:
- Pilocytic astrocytoma (PA) is a common brain tumor in children and young adults.
- Understanding prognostic factors is crucial for treatment planning.
Purpose of the Study:
- To evaluate the impact of surgical resection extent on outcomes in pilocytic astrocytoma patients.
- To assess the role of additional therapies in patients with non-gross total resection.
Main Methods:
- Retrospective review of 31 pilocytic astrocytoma patients treated between 1988 and 2018.
- Analysis of disease-specific survival (DSS) and progression-free survival (PFS) based on gross total resection (GTR) and additional treatments.
Main Results:
- 10-year PFS was significantly higher in the GTR group (100%) compared to the non-GTR group (30.7%; p=0.012).
- No significant difference in 10-year DSS was observed between GTR and non-GTR groups.
- Additional chemotherapy and/or radiotherapy did not significantly impact DSS or PFS in the non-GTR group.
Conclusions:
- Progression-free survival in pilocytic astrocytoma is primarily determined by the extent of surgical resection and tumor location.
- The study highlights the importance of GTR for improving PFS.
- Further multicenter, prospective studies are needed to validate these findings due to the study's limitations.
Background:
Pilocytic astrocytoma (PA) is a brain tumor that is relatively more common in children and young adults.
Methods:
We retrospectively reviewed the medical records of patients with PA treated at a single center between 1988 and 2018.
Results:
We included 31 subjects with PA. The median age at diagnosis was 13.4 years, and the median follow-up duration was 9.9 years. The total PA group had a 10-year disease-specific survival (DSS) rate of 92.6% [95% confidence interval (CI), 82.6-100] and 10-year progression-free survival (PFS) rate of 52.8% (95% CI, 32.0-73.6). In patients aged <20 years, tumors were more likely to be located in sites in which gross total tumor resection (GTR) was impossible. No statistically significant difference in 10-year DSS was found between the GTR (100%) and non-GTR (89.7%; 95% CI, 76.2-100; p=0.374) groups. However, a statistically significant difference in 10-year PFS was found between the GTR (100%) and non-GTR groups (30.7%; 95% CI, 8.6-52.8; p=0.012). In the non-GTR group, no statistically significant difference in 10-year DSS was found between the patients who received immediate additional chemotherapy and/or radiotherapy (Add-Tx group, 92.9%; 95% CI, 79.4-100) and the non-Add-Tx group (83.3%; 95% CI, 53.5-100; p=0.577). No statistically significant difference in 10-year PFS was found between the Add-Tx group (28.9%; 95% CI, 1.7-56.1) and non-Add-Tx group (33.3%; 95% CI, 0-70.9; p=0.706).
Conclusion:
The PFS of the patients with PA in our study depended only on the degree of surgical excision associated with tumor location. This study is limited by its small number of patients and retrospective nature. A multicenter and prospective study is necessary to confirm these findings.
