title: Outcome and prognostic features in adult pineoblastomas: analysis of cases from the SEER database.
abstract: BACKGROUND
  Adult pineoblastomas (PBL) are rare central nervous system tumors. Patient and treatment factors associated with outcome are poorly defined and limited to small retrospective case series and single case reports. Using the Surveillance, Epidemiology, and End Results (SEER) cancer registry, we investigated clinicopathological factors associated with outcome in adult PBL.
  
  
  METHODS
  Adult patients (≥16 years old) with PBL diagnosed between 1990 and 2007 were identified from the SEER database. Kaplan-Meier survival analysis and Cox models were used to examine the effect of variables on overall survival. The variables analyzed included patient's age at diagnosis, gender, race, tumor location, uni-focal or multi-focal tumor, tumor size, surgical resection, and the use of adjuvant radiotherapy.
  
  
  RESULTS
  Ninety-five patients were identified, with a median age at diagnosis of 39.2 years. Sixty-one patients (64 %) underwent surgery and 44 patients (47.4 %) received adjuvant radiotherapy. Forty-two patients (44 %) had both surgery and radiotherapy. The median overall survival was 176 months. Univariate analysis identified younger age at diagnosis, uni-focal and localized disease as important predictors of overall survival. On multivariate analysis, only age at diagnosis and localized disease emerged as important prognostic factors.
  
  
  CONCLUSIONS
  Despite the numerous limitations of the SEER database, this study represents the largest analysis of adult PBL to date. Clinically relevant prognostic factors were younger age of diagnosis and localized disease. The role of surgery and adjuvant radiotherapy remains to be defined. Our data suggest these treatment modalities may not influence overall survival.
authors.affiliation: Department of Neurosurgery, Leeds General Infirmary, UK. senthil-kumar@doctors.org.uk
authors.forename: Senthil K
authors.initials: SK
authors.lastname: Selvanathan
authors.forename: Salah
authors.initials: S
authors.lastname: Hammouche
authors.forename: Wendy
authors.initials: W
authors.lastname: Smethurst
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Salminen
authors.forename: Michael D
authors.initials: MD
authors.lastname: Jenkinson
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010870:Pineal Gland / Q000601:surgery*; D010871:Pinealoma / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D055815:Young Adult