Park Sanghyeok, Seo Jung Han, Song Sang Woo, Cho Young Hyun, Hong Chang-Ki, Kim Jeong Hoon, Kim Ho Sung, Park Ji Eun, Nam Soo Jung, Kim Young-Hoon
Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Front Oncol. 2025 Apr 1;15:1525427. doi: 10.3389/fonc.2025.1525427. eCollection 2025.
Pilocytic astrocytomas (PA) in adult patients are rare and the efficacy of postoperative adjuvant treatments remains unclear. This study aims to investigate the survival outcome and prognostic factors in surgically treated adult PA.
A total of 90 consecutive adult patients with newly diagnosed PA were enrolled. Among the patients, 47 (52%) were male, with a median age of 28 years (18-70 years). Preoperative neurological deficits were observed in 43 (48%) patients. The most common tumor locations were cerebellar and cerebral hemispheres (28% and 27%, respectively), while 23% of tumors were located in deeper brain structures. The median follow-up duration was 88months (12-304 months).
Gross total removal (GTR) was achieved in 55 (61%) patients. At the final follow-up, 12 (13%) patients had died, and 23 (26%) experienced disease progression. The 1, 2, and 5-year overall survival (OS) rates were 93%, 91%, and 87%, respectively, while the progression-free survival (PFS) rates were 88%, 80%, and 77%, respectively. The recurrence rate in patients who underwent GTR was 11%, compared with 53% and 45% in those without GTR, with or without adjuvant treatments, respectively. The tumors in the deeper brain locations had significantly lower GTR rates (14%) compared with other locations (75%; < 0.001). Multivariate analysis identified the absence of preoperative neurological deficits ( = 0.048; HR = 2.878), not deeper tumor location ( = 0.017; HR = 3.471) and GTR ( = 0.007; HR = 3.884) as significant factors for improved PFS.
Adult PA exhibited more aggressive behavior compared with pediatric PA. These aggressive behaviors including preoperative neurological deficits, deeper tumor location, and lower GTR rates were significantly associated with poor prognosis.
成年患者的毛细胞型星形细胞瘤（PA）较为罕见，术后辅助治疗的疗效尚不清楚。本研究旨在调查手术治疗的成年PA患者的生存结局和预后因素。
共纳入90例连续的新诊断成年PA患者。其中，47例（52%）为男性，中位年龄为28岁（18 - 70岁）。43例（48%）患者术前存在神经功能缺损。最常见的肿瘤部位是小脑和大脑半球（分别为28%和27%），而23%的肿瘤位于脑深部结构。中位随访时间为88个月（12 - 304个月）。
55例（61%）患者实现了全切除（GTR）。在最后一次随访时，12例（13%）患者死亡，23例（26%）出现疾病进展。1年、2年和5年总生存率（OS）分别为93%、91%和87%，无进展生存率（PFS）分别为88%、80%和77%。接受GTR的患者复发率为11%，而未接受GTR的患者，无论是否接受辅助治疗，复发率分别为53%和45%。与其他部位（75%）相比，脑深部肿瘤部位的GTR率显著较低（14%；P < 0.001）。多因素分析确定术前无神经功能缺损（P = 0.048；HR = 2.878）、肿瘤部位不深（P = 0.017；HR = 3.471）和GTR（P = 0.007；HR = 3.884）是改善PFS的重要因素。
与儿童PA相比，成年PA表现出更具侵袭性的行为。这些侵袭性行为包括术前神经功能缺损、肿瘤部位深和GTR率低，与预后不良显著相关。
