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. 2021 Oct 26;16(10):e0259095.
doi: 10.1371/journal.pone.0259095. eCollection 2021.

Clinical profile, treatment and outcome of pediatric brain tumors in Serbia in a 10-year period: A national referral institution experience

Dragana Stanić  1   2 , Danica Grujičić  1   3   4 , Tatjana Pekmezović  1   5 , Jelena Bokun  1   2 , Marija Popović-Vuković  2 , Dragana Janić  1   4 , Lejla Paripović  4 , Vesna Ilić  4 , Marija Pudrlja Slović  4 , Rosanda Ilić  1   3 , Savo Raičević  3 , Milan Sarić  6 , Ivana Mišković  6 , Borko Nidžović  6 , Marina Nikitović  1   2
Affiliations

Clinical profile, treatment and outcome of pediatric brain tumors in Serbia in a 10-year period: A national referral institution experience

Dragana Stanić et al. PLoS One. .

Abstract

Objective: This study aimed to evaluate the characteristics of children with primary brain tumors, the effectiveness of treatment modalities, and to detect factors related to the outcome.

Methods: A detailed analysis was performed on a series of 173 pediatric patients treated in a Serbian referral oncology institution between 2007 and 2016, based on their clinical, histological, treatment, and follow-up data.

Results: Mean survival time of all children was 94.5months. 2-, 5- and 10-year overall survival probabilities were 68.8%, 59.4%, and 52.8%, respectively. Patients with supratentorial tumors had longer survival than patients with infratentorial tumors and patients with tumors in both compartments (p = 0.011). Children with the unknown histopathology (brainstem glioma) and high-grade glioma had a shorter life than embryonal tumors, ependymoma, and low-grade glioma (p<0.001). Survival of the children who underwent gross total resection was longer than the children in whom lesser degrees of resection were achieved (p = 0.015). The extent of the disease is a very important parameter found to be associated with survival. Patients with no evidence of disease after surgery had a mean survival of 123 months, compared with 82 months in patients with local residual disease and 55 months in patients with disseminated disease (p<0.001). By the univariate analysis, factors predicting poor outcome in our series were the presentation of disease with hormonal abnormalities, tumor location, and the extent of the disease, while the factors predicting a better outcome were age at the time of diagnosis, presentation of the disease with neurological deficit, and type of resection. By the multivariate analysis, the extent of the disease remained as the only strong adverse risk factor for survival (HR 2.06; 95% CI = 1.38-3.07; p<0.001).

Conclusions: With an organized and dedicated multidisciplinary team, the adequate outcomes can be achieved in a middle-income country setting. The presence of local residual disease after surgery and disseminated disease has a strong negative effect on survival.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Cumulative survival of children with brain tumors.
Fig 2
Fig 2. Cumulative survival of children with brain tumors according to age.
Fig 3
Fig 3. Cumulative survival of children with brain tumors according to tumor location.
ST—supratentorial tumors, IT—infratentorial tumors, Both—tumors with both (supratentorial and infratentorial) locations involvement.
Fig 4
Fig 4. Cumulative survival of children with brain tumors according to tumor histopathological type.
ET–embryonal tumors, HGG–high-grade glioma, LGG–low-grade glioma, EP–ependymoma, UH–unknown histopathological type.
Fig 5
Fig 5. Cumulative survival of children with brain tumors according to type of resection.
GTR–gross total resection, NGTR–non-gross total resection.
Fig 6
Fig 6. Cumulative survival of children with brain tumors according to extent of the disease.
NED–no evidence disease, LRD–local residual disease, DD–disseminated disease.
See this image and copyright information in PMC

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