Dono Antonio, Lopez-Rivera Victor, Chandra Ankush, Lewis Cole T, Abdelkhaleq Rania, Sheth Sunil A, Ballester Leomar Y, Esquenazi Yoshua
Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston - McGovern Medical School, Houston, Texas.
Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, Texas.
Neurooncol Pract. 2020 Nov 20;8(2):222-229. doi: 10.1093/nop/npaa076. eCollection 2021 Apr.
Pleomorphic xanthoastrocytomas (PXA) are circumscribed gliomas that typically have a favorable prognosis. Limited studies have revealed factors affecting survival outcomes in PXA. Here, we analyzed the largest PXA dataset in the literature and identify factors associated with outcomes.
Using the Surveillance, Epidemiology, and End Results (SEER) 18 Registries database, we identified histologically confirmed PXA patients between 1994 and 2016. Overall survival (OS) was analyzed using Kaplan-Meier survival and multivariable Cox proportional hazard models.
In total, 470 patients were diagnosed with PXA (males = 53%; median age = 23 years [14-39 years]), the majority were Caucasian (n = 367; 78%). The estimated mean OS was 193 months [95% CI: 179-206]. Multivariate analysis revealed that greater age at diagnosis (≥39 years) (3.78 [2.16-6.59], < .0001), larger tumor size (≥30 mm) (1.97 [1.05-3.71], = .034), and postoperative radiotherapy (RT) (2.20 [1.31-3.69], = .003) were independent predictors of poor OS. Pediatric PXA patients had improved survival outcomes compared to their adult counterparts, in which chemotherapy (CT) was associated with worse OS. Meanwhile, in adults, females and patients with temporal lobe tumors had an improved survival; conversely, tumor size ≥30 mm and postoperative RT were associated with poor OS.
In PXA, older age and larger tumor size at diagnosis are risk factors for poor OS, while pediatric patients have remarkably improved survival. Postoperative RT and CT appear to be ineffective treatment strategies while achieving GTR confer an improved survival in male patients and remains the cornerstone of treatment. These findings can help optimize PXA treatment while minimizing side effects. However, further studies of PXAs with molecular characterization are needed.
多形性黄色星形细胞瘤（PXA）是一种边界清晰的胶质瘤，通常预后良好。有限的研究揭示了影响PXA生存结果的因素。在此，我们分析了文献中最大的PXA数据集，并确定了与预后相关的因素。
使用监测、流行病学和最终结果（SEER）18登记数据库，我们确定了1994年至2016年间经组织学确诊的PXA患者。使用Kaplan-Meier生存分析和多变量Cox比例风险模型分析总生存期（OS）。
总共470例患者被诊断为PXA（男性占53%；中位年龄 = 23岁[14 - 39岁]），大多数为白种人（n = 367；78%）。估计的平均总生存期为193个月[95%置信区间：179 - 206]。多变量分析显示，诊断时年龄较大（≥39岁）（3.78[2.16 - 6.59]，P <.0001）、肿瘤较大（≥30 mm）（1.97[1.05 - 3.71]，P =.034）以及术后放疗（RT）（2.20[1.31 - 3.69]，P =.003）是总生存期较差的独立预测因素。与成年患者相比，儿童PXA患者的生存结果有所改善，其中化疗（CT）与较差的总生存期相关。同时，在成年人中，女性和颞叶肿瘤患者的生存期有所改善；相反，肿瘤大小≥30 mm和术后放疗与较差的总生存期相关。
在PXA中，诊断时年龄较大和肿瘤较大是总生存期较差的危险因素，而儿童患者的生存期有显著改善。术后放疗和化疗似乎是无效的治疗策略，而实现肿瘤全切除（GTR）可改善男性患者的生存期，并且仍然是治疗的基石。这些发现有助于优化PXA的治疗，同时将副作用降至最低。然而，需要对具有分子特征的PXA进行进一步研究。
