Global Trends in Survival From Astrocytic Tumors in Adolescents and Young Adults: A Systematic Review

Abstract

Background: Brain tumors represent an important cause of cancer-related death in adolescents and young adults. Most are diagnosed in low-income and middle-income countries. We aimed to conduct the first, to our knowledge, systematic review of time trends and geographical variation in survival in this age group.

Methods: We included observational studies describing population-based survival from astrocytic tumors in patients aged 15-39 years. We queried 6 electronic databases from database inception to December 31, 2019. This review is registered with PROSPERO, number CRD42018111981.

Results: Among 5640 retrieved records, 20 studies fulfilled the inclusion criteria. All but 1 study focused on high-income countries. Five-year survival from astrocytoma (broad morphology group) mostly varied between 48.0% and 71.0% (1973-2004) without clear trends or geographic differences. Adolescents with astrocytoma had better outcomes than young adults, but survival values were similar when nonmalignant tumors were excluded. During 2002-2007, 5-year survival for World Health Organization grade I-II tumors was in the range of 72.6%-89.1% in England, Germany, and the United States but lower in Southeastern Europe (59.0%). Five-year survival for anaplastic astrocytoma varied between 39.6% and 55.4% (2002-2007). Five-year survival from glioblastoma was in the range of 14.2%-23.1% (1991-2009).

Conclusions: Survival from astrocytic tumors remained somewhat steady over time, with little change between 1973 and 2009. Survival disparities were difficult to examine, because nearly all the studies were conducted in affluent countries. Studies often adopted the International Classification of Childhood Cancer, which, however, did not allow to accurately describe variation in survival. Larger studies are warranted, including underrepresented populations and providing more recent survival estimates.

Figure 1.

Preferred reporting items for Systematic Reviews and Meta-Analyses flowchart.

Figure 2.

Five-year survival (percentage) from astrocytoma (broad morphology group). Error bars are 95% confidence intervals. For studies providing only point survival estimates, confidence intervals are shown as (survival estimate ±1%).

Figure 3.

Five-year survival (percentage) from astrocytoma (broad morphology group) by age group (adolescents, or adolescents and young adults combined) and tumor behavior (nonmalignant plus malignant, or malignant only). Error bars are 95% confidence intervals. For studies providing only point survival estimates, confidence intervals are shown as (survival estimate ±1%).

Figure 4.

Five-year survival (percentage) from astrocytoma (low grade), pilocytic astrocytoma, diffuse astrocytoma, astrocytoma (high grade), anaplastic astrocytoma, and glioblastoma. Error bars are 95% confidence intervals. For studies providing only point survival estimates, confidence intervals are shown as (survival estimate ±1%).