Sullivan Jared, Chandler James, Lesniak Maciej, Tate Matthew, Sonabend Adam, Kalapurakal John, Horbinski Craig, Lukas Rimas, Kumthekar Priya, Sachdev Sean
Northwestern University.
Northwestern University Robert H. Lurie Comprehensive Cancer Center.
Res Sq. 2023 Feb 3:rs.3.rs-2535551. doi: 10.21203/rs.3.rs-2535551/v1.
Report our institutional experience with pleomorphic xanthoastrocytoma (PXA) to contribute to limited data on optimal management.
Patients with pathologically confirmed PXA treated at our institution between 1990 and 2019 were identified. Demographic information, tumor grade, treatment variables, and clinical outcomes were collected from patient charts. Kaplan-Meier estimates were used to summarize two primary outcome measurements: progression-free survival (PFS) and overall survival (OS). Outcomes were stratified by tumor grade and extent of resection. Cox regression and log-rank testing were performed.
We identified 17 patients with pathologically confirmed PXA. Two patients were excluded due to incomplete treatment information or < 6m of follow-up; 15 patients were analyzed (median follow-up 4.4y). Six patients had grade 2 PXA and 9 had grade 3 anaplastic PXA. The 2-year and 5-year PFS for the cohort was 57% and 33%, respectively; 2-year and 5-year OS was 93% and 75%, respectively. Patients with grade 2 tumors exhibited superior PFS compared to those with grade 3 tumors (2-year PFS: 100% vs. 28%, 5-year PFS: 60% vs. 14%), hazard ratio, 5.09 (95% CI:1.06-24.50), p = 0.02. Undergoing a GTR also yielded improved outcomes (hazard ratio: 0.38, p = 0.15). All but one (89%) of the grade 3 patients underwent RT.
The poor survival of the cohort, especially with grade 3 tumors, suggests the need for more aggressive treatment, including maximal resection followed by intensive adjuvant therapy. Better prognostics of tumor recurrence are needed to guide the use of adjuvant therapy.
报告我们机构在多形性黄色星形细胞瘤（PXA）方面的经验，以补充关于最佳治疗管理的有限数据。
确定1990年至2019年期间在我们机构接受病理确诊为PXA治疗的患者。从患者病历中收集人口统计学信息、肿瘤分级、治疗变量和临床结果。采用Kaplan-Meier估计法总结两个主要结局指标：无进展生存期（PFS）和总生存期（OS）。结局按肿瘤分级和切除范围进行分层。进行Cox回归和对数秩检验。
我们确定了17例病理确诊为PXA的患者。2例患者因治疗信息不完整或随访时间<6个月而被排除；对15例患者进行了分析（中位随访时间4.4年）。6例患者为2级PXA，9例为3级间变性PXA。该队列的2年和5年PFS分别为57%和33%；2年和5年OS分别为93%和75%。2级肿瘤患者的PFS优于3级肿瘤患者（2年PFS：100%对28%，5年PFS：60%对14%），风险比为5.09（95%CI：1.06 - 24.50），p = 0.02。接受根治性手术切除（GTR）也能改善结局（风险比：0.38，p = 0.15）。除1例（89%）3级患者外，所有患者均接受了放疗。
该队列患者的生存率较差，尤其是3级肿瘤患者，这表明需要更积极的治疗，包括最大程度切除后进行强化辅助治疗。需要更好地预测肿瘤复发，以指导辅助治疗的使用。
