The Epidemiological Characteristics and Prognostic Factors of Low-Grade Brainstem Glioma: A Real-World Study of Pediatric and Adult Patients

Abstract

Purpose: Our current understanding of low-grade brainstem glioma (LGBSG) is still limited. This study aimed to conduct a large-scale population-based real-world study to understand the epidemiological characteristics of LGBSG and determine the predictive factors of cancer-specific survival (CSS) and overall survival (OS) of LGBSG patients. Patients and Methods: We used Surveillance Epidemiology and End Results database to conduct this study of patients with histologically confirmed LGBSG. Patient demographics, tumor characteristics, and treatment options were compared between pediatric and adult patients. Univariate and multivariate analyses were employed to determine prognostic factors of CSS and OS. Kaplan-Meier curve and decision tree were used to confirm the prognostic factors. All variables were further identified by L1-penalized (Lasso) regression and then a nomogram was established to predict the 5-and 8-year CSS and OS rate. The precision of the nomogram was evaluated by calibration plots, Harrell's concordance index, and time-dependent receiver operating characteristic curve. The clinical use of nomogram was estimated by decision curve analysis. Results: A cohort of 305 patients with LGBSG, including 165 pediatric and 140 adult patients, was analyzed. Adult and pediatric patients showed different patterns concerning tumor size, tumor extension, adjuvant therapy, and survival rate. Univariate analysis revealed that pediatric group, gross total resection (GTR), World Health Organization grade II, radiotherapy, extension to ventricular system, and diffuse astrocytic and oligodendroglial tumor (DAOT) were significantly associated with CSS. Multivariate analysis showed that pediatric group, metastasis, ventricular system involvement, and DAOT were independently associated with CSS. The prognostic factors were further confirmed by Kaplan-Meier curve and decision tree. Kaplan-Meier curve also showed Liu et al. Low-Grade Brainstem Glioma that adjuvant therapy added no benefits in patients with GTR and non-GTR. In addition, the nomogram was developed and the C-index of internal validation for CSS was 0.87 (95% CI, 0.78-0.96). Conclusion: This study shows that pediatric and adult patients have different tumor characteristics, treatment options, and survival rate. Pediatric group, DAOT, ventricular system involvement, and metastasis were identified as independent prognostic factors for CSS by multivariate analysis. Adjuvant therapy showed no benefits on CSS in patients with GTR and non-GTR. The nomogram was discriminative and clinically useful.

Epidemiology and Survival of Patients With Brainstem Gliomas: A Population-Based Study Using the SEER Database

“…Children and adolescents (0-19 years old) accounted for 34.3% of all patients, and more than half of the patients were adults. The predominance of white patients was also very significant in our study, which is consistent with the findings of other cohort studies of gliomas based on the SEER program (13,16). Males and females are almost equally affected.…”

Nomograms individually predict the overall survival and cancer-specific survival of adult patients with hemispheres lower-grade gliomas: A SEER-Based Study

“…Many previous studies have shown the accurate predictive ability of nomograms for predicting overall survival in patients with low-grade endometrial stromal sarcoma [10], adrenocortical carcinoma [15], hepatoblastoma [16], and many other system cancers. So far, only a few sporadic studies have investigated the straightforward application of nomograms in glioma based on the SEER database [17][18][19][20]. WHO grade II/III glioma is a relatively rare tumour, with no individualized prognostic predictive tool to manage follow-up and aid accurate prognostic assessment.…”

Hsa_circ_0110757 upregulates ITGA1 to facilitate temozolomide resistance in glioma by suppressing hsa-miR-1298-5p

“…A total of 10 7 U87/R cells transfected with the si-hsa_circ_0110757 precursor were subcutaneously injected into BALB/c nude mice. When the tumor volume reached 100 mm 3 , TMZ (60 mg/kg) was applied intraperitoneally and tumor volume was measured every 2 days. After 15 days, the whole mice were systemically anesthetized and tumor tissues were collected for RT-PCR, western blot, and immunofluorescence assays.…”

“…Glioma, originating from the neuroepithelium and accounting for 40–50% of intracranial tumors, is the most common malignant tumor of the central nervous system 1 , 2 . The main characteristics are diffuse invasive growth of tumor cells, unclear boundaries, relatively unlimited proliferation, and high invasiveness, all of which seriously affect human health 3 . Despite advances in the treatment of gliomas, the 5-year survival rate of glioma patients remains low 4 .…”