1Emory University School of Medicine, Atlanta.
2Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta.
Neurosurg Focus. 2024 Aug 1;57(2):E13. doi: 10.3171/2024.5.FOCUS2486.
Pediatric pilocytic astrocytoma (PPA) requires prolonged follow-up after initial resection. The landscape of transitional care for PPA patients is not well characterized. The authors sought to examine the clinical course and transition to adult care for these patients to better characterize opportunities for improvement in long-term care.
Pediatric patients (younger than 18 years at diagnosis) who underwent biopsy or resection for PPA between May 2000 and November 2022 at the authors' large academic center were retrospectively reviewed. Patient demographics, tumor characteristics, recurrence, adjuvant therapies, and follow-up data were extracted from the electronic medical record via chart review. Charts of patients who were 18 years or older as of January 1, 2024, were reviewed for adult follow-up notes.
The authors identified 315 patients who underwent biopsy or resection for PPA between May 2000 and November 2022. The most common tumor location was posterior fossa (59.7%), and gross-total resection (GTR) was achieved in 187 patients (59.4%). In patients with GTR, progression/recurrence occurred less frequently (8.6% vs 41.4%, p < 0.01) compared to patients with non-GTR. Among 177 patients found to be age-eligible for transition to adult care, the authors found that 31 (17.5%) successfully transitioned. The average age at transition from pediatric to adult care was 21.7 years, and the average age at last known adult follow-up was 25.0 years. The authors found that patients who transitioned to adult care were followed longer (12.5 vs 7.0 years, p < 0.01) and were diagnosed at an older age (12.1 vs 9.6 years, p < 0.01) than their untransitioned counterparts.
The authors found that there was a low rate of successful transition from pediatric to adult care for PPA; 17.5% of age-eligible patients are now cared for by adult providers, whereas an additional 18.6% completed appropriate follow-up during childhood and did not require transition to adult care. These findings underscore opportunities for improvement in the pediatric-to-adult transition process for patients with PPA, particularly for those with non-GTR who were not followed for at least 10 years, during which the risk of disease progression is thought to be highest.
小儿毛细胞型星形细胞瘤（PPA）在初次切除后需要长期随访。PPA 患者过渡护理的情况尚不清楚。作者旨在研究这些患者的临床过程和向成人护理的过渡，以更好地确定长期护理中改进的机会。
回顾性分析 2000 年 5 月至 2022 年 11 月期间在作者所在大型学术中心接受活检或切除术治疗的小儿（诊断时年龄小于 18 岁）PPA 患者。通过病历回顾从电子病历中提取患者人口统计学、肿瘤特征、复发、辅助治疗和随访数据。截至 2024 年 1 月 1 日年满 18 岁的患者的病历将进行成人随访记录审查。
作者共纳入 315 例 2000 年 5 月至 2022 年 11 月间接受活检或切除术治疗的 PPA 患者。最常见的肿瘤部位是后颅窝（59.7%），187 例（59.4%）患者达到大体全切除（GTR）。在 GTR 患者中，进展/复发的发生率较低（8.6%比 41.4%，p < 0.01），而非 GTR 患者的进展/复发发生率较高。在 177 例符合向成人护理过渡年龄标准的患者中，作者发现 31 例（17.5%）成功过渡。从儿科到成人护理的平均过渡年龄为 21.7 岁，最后一次已知的成人随访平均年龄为 25.0 岁。作者发现，过渡到成人护理的患者随访时间更长（12.5 年比 7.0 年，p < 0.01），诊断年龄更大（12.1 岁比 9.6 岁，p < 0.01）。
作者发现，PPA 患者从儿科到成人护理的成功过渡率较低；17.5%的年龄符合标准的患者现在由成人提供者照顾，而另外 18.6%的患者在儿童期完成了适当的随访，无需过渡到成人护理。这些发现强调了需要改进 PPA 患者从儿科到成人护理的过渡过程，特别是对于那些非 GTR 患者，他们至少没有随访 10 年，在此期间疾病进展的风险被认为最高。
