Pilocytic Astrocytoma: An institutional perspective over the last decade

Area of Science:

• Pediatric Oncology
• Neurosurgery
• Clinical Pathology

Background:

• Pilocytic astrocytoma is a common pediatric brain tumor, typically originating in the cerebellum with a generally favorable prognosis.
• The prognostic value of patient age, tumor location, and extent of surgical resection for pilocytic astrocytoma remains a subject of ongoing debate.
• This study evaluates clinicopathological and radiological features to identify prognostic factors and survival outcomes in pilocytic astrocytoma patients.

Purpose of the Study:

• To evaluate clinicopathological and radiological features of pilocytic astrocytoma.
• To identify prognostic factors influencing patient outcomes.
• To assess 1- and 5-year progression-free survival (PFS) and 1-, 5-, and 10-year overall survival (OS).

Main Methods:

• Retrospective analysis of 101 patients with histologically confirmed pilocytic astrocytoma (2013-2022).
• Data collection included demographics, clinical presentation, tumor characteristics, extent of resection, and adjuvant therapy.
• Survival outcomes were analyzed using Kaplan-Meier and Cox regression methods (p < 0.05).

Main Results:

• The study included 101 patients (52.5% male), with 59 pediatric cases (<14 years). Cerebellum was the most common tumor site.
• Gross total resection (GTR) was achieved in 43.0% of patients. 1-year OS was 92%, 5-year OS was 87%, and 10-year OS was 83%.
• 1-year PFS was 50%, and 5-year PFS was 10%. Trends for better OS were observed with GTR/NTR, cystic tumors, pediatric age, and absence of leptomeningeal dissemination, though not statistically significant.

Conclusions:

• This study reports pilocytic astrocytoma survival rates in a low-and-middle-income country population for the first time.
• Survival trends showed variation based on age, leptomeningeal disease, extent of resection, and radiological tumor patterns.
• Cox regression identified radiological patterns, CNS infections, and endocrinological dysfunction as key predictors of overall survival.