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. 2009 Dec 15;115(24):5761-70.
doi: 10.1002/cncr.24663.

Outcome and prognostic features in pediatric gliomas: a review of 6212 cases from the Surveillance, Epidemiology, and End Results database

Ibrahim Qaddoumi  1 , Iyad Sultan, Amar Gajjar
Affiliations

Outcome and prognostic features in pediatric gliomas: a review of 6212 cases from the Surveillance, Epidemiology, and End Results database

Ibrahim Qaddoumi et al. Cancer. .

Abstract

Background: Pediatric gliomas are rare and heterogeneous tumors. The Surveillance, Epidemiology, and End Results (SEER) database allows a large-scale analysis of the clinical characteristics and prognostic features of these tumors.

Methods: The authors analyzed available SEER data on 6212 patients younger than 20 years at diagnosis of glioma (1973-2005), according to 4 age categories: <1 year, 1-3 years, 3-5 years, and 5-20 years.

Results: The overall 5- and 10-year survival estimates were 71%+/-0.62% (standard error) and 68%+/-0.67%, respectively. Forty-one percent of gliomas were cerebral; the frequency of cerebellar tumors (22%-32% of gliomas) increased sharply after the first year of life. Of the tumors for which grade was available, 77% were low grade (grade I or II). Tumor grade emerged as the most significant independent prognostic factor in all age groups except the youngest age group, in which extent of resection was most significant. Surgery other than gross total resection was an adverse prognostic factor (hazard ratio, 2.18; 95% confidence interval, 1.78-2.67). Age<3 years predicted a greater likelihood of survival in patients with high-grade gliomas and brainstem tumors. Conversely, age<3 years predicted a lower likelihood of survival in patients with low-grade gliomas. Children aged<1 year received less radiotherapy than older patients (P<.0001) and were less likely to undergo gross total resection (P<.0001).

Conclusions: The survival of children with gliomas is influenced by histologic subtype, age, and extent of resection. Despite its limitations, the SEER database provides a useful tool for studies of rare tumors such as pediatric gliomas.

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Figures

Figure 1
Figure 1
(A) Bar histogram showing the relative frequency of gliomas versus other CNS tumors in 9192 pediatric patients with CNS tumors diagnosed between 1973 and 2005. (B) Distribution of the proportion of gliomas that were high-grade (grade III and IV) according to primary site and age group.
Figure 2
Figure 2
Relative frequency of glioma (A) grade, (B) site, (C) histology, and (D) extent of surgery, according to age group.
Figure 3
Figure 3
Survival of pediatric patients with gliomas according to (A) tumor grade (n=4456), (B) age (n=6212), (C) tumor site (n=6212), and (D) extent of surgery (GTR, gross total resection) (n=6212). The log-rank test was used to compare survival curves.
Figure 4
Figure 4
Line charts comparing the 10-year Kaplan-Meier survival estimates of pediatric patients with gliomas in the 4 age groups according to (A) histology, (B) tumor grade, (C) primary tumor site, and (D) extent of surgery. The log-rank test for trend was used to test the association of age with survival in each subset of patients.
See this image and copyright information in PMC

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