Survival of children with infratentorial neuroglial tumors. The Childhood Brain Tumor Consortium.
OBJECTIVE
The goal of this study is the improvement of the prognostic information associated with conventional diagnoses. Our previous factor analysis of 26 reliably identified histological features in infratentorial childhood neuroglial tumors yielded five interpretable, uncorrelated, quantitative histological factors that we named spongy, fibrillary, proliferative, nuclear, and ring. Five quantitative scores, one for each of the five factors, provide an objective method for quantifying the histological heterogeneity of a tumor. The scores, alone or in conjunction with conventional diagnoses, identify groups of histologically homogeneous tumors.


METHODS
Multivariate Cox proportional hazards models were developed to assess the contribution of each factor to survival prognosis, after allowing patient-specific demographic and clinical data in the models as covariates. Hazard ratios, estimated for each statistically significant factor and covariate in the multivariate model, provide the basis for the determination of the prognosis. The hazard ratio is the ratio of the hazard function for subjects with an attribute, e.g., an age of 10 years, to the hazard function for subjects who have some chosen baseline attribute, e.g., an age of 1 year. The important criterion of this ratio is beta, a statistic estimated from the survival data in the Childhood Brain Tumor Consortium database of infratentorial neuroglial tumors. Kaplan-Meier survival curves were used to investigate differences in the survival of factor-determined subgroups of patients with various diagnoses.


RESULTS
An increased likelihood of survival is associated with older age, more tumor removal, more recent decade of surgical intervention, and high spongy and fibrillary factor scores. A decreased likelihood of survival is associated with high nuclear, proliferative, and ring factor scores. Gender, location within the infratentorial compartment, and subsequent treatment did not add prognostic information. For certain subgroups of astrocytoma and for ependymoma and medulloblastoma, factors are important in predicting survival with greater accuracy.


CONCLUSIONS
Factor scores provide clinically useful quantitative estimates of survival probability that are more specific and accurate than the general estimates based on the conventional diagnosis alone.
Sobel
E L
EL
Department of Preventive Medicine (Biostatistics), University of Southern California School of Medicine, Los Angeles, USA.
Gilles
F H
FH
Leviton
A
A
Tavaré
C J
CJ
Hedley-Whyte
E T
ET
Rorke
L B
LB
Adelman
L S
LS
D000293:Adolescent; D001254:Astrocytoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D002528:Cerebellar Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004806:Ependymoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007223:Infant; D015192:Infratentorial Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D008297:Male; D008527:Medulloblastoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome