title: Pleomorphic xanthoastrocytoma: long-term results of surgical treatment and analysis of prognostic factors.
abstract: BACKGROUND
  Pleomorphic Xanthoastrocytoma (PXA) is a rare brain tumour, most commonly affecting children and young adults. To date, only few data regarding the long-term follow-up of these patients after surgery are available. The aim of this study is to describe our single-institution experience in the surgical management of this particular glioma over a period of over 18 years.
  
  
  METHODS
  We performed a retrospective review of all cases of PXA (40 patients) operated upon at the Department of Neurosurgery of Verona, Italy, between 1990 and 2008. The impact of clinical, radiological, surgical and histological factors on overall survival (OS) and progression-free survival (PFS) was analysed by means of univariate and multivariate models.
  
  
  RESULTS
  We achieved a gross total resection (GTR) in 65% of patients. Histological diagnosis was of grade II in 80%; anaplastic features were present in the remaining 20%. Adjuvant treatment, radiotherapy or chemo-radiotherapy, was administered in 40% of the cases. Median follow-up was 74 months. OS at 5- and 10 years was 76.32% and 68.24%, respectively. PFS at 5- and 10 years was 71% and 58%, respectively. In the multivariate model, histological grade, extent of resection and age at diagnosis (≤ 30 years vs > 30 years) were the only independent prognostic factors for both OS and PFS.
  
  
  CONCLUSIONS
  Our retrospective long-term study confirms the relatively favourable prognosis associated with PXA. Young patients with a low-grade tumour (WHO grade II) who underwent GTR carry the longest OS and PFS.
authors.affiliation: Department of Neurosurgery, University Hospital , Verona , Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Gallo
authors.forename: Paolo Cipriano
authors.initials: PC
authors.lastname: Cecchi
authors.forename: Francesca
authors.initials: F
authors.lastname: Locatelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Rizzo
authors.forename: Claudio
authors.initials: C
authors.lastname: Ghimenton
authors.forename: Massimo
authors.initials: M
authors.lastname: Gerosa
authors.forename: Giampietro
authors.initials: G
authors.lastname: Pinna
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D001254:Astrocytoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D003399:Craniotomy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult