title: Analysis of risk factors and survival in pediatric high-grade spinal cord astrocytoma: a population-based study.
abstract: OBJECTIVE
  Primary pediatric high-grade spinal cord astrocytomas are rare neoplasms with poor prognoses. Using the Surveillance, Epidemiology, and End Results (SEER) database, we analyzed prognostic factors and survival.
  
  
  METHODS
  Pediatric patients with histologically confirmed diagnoses of primary high-grade spinal cord astrocytoma (WHO grade III-IV) from 1973 to 2008 in the SEER database were studied. Univariate and multivariate Cox proportional hazards models were used to analyze the relationship between demographic, tumor grade, and treatment factors on survival.
  
  
  RESULTS
  Median survival in the 48 patient cohort was 10 months. Increasing age and higher tumor grade were found to be significantly associated with higher mortality. For children aged <7, 7-12, and 13-18 years, median survival was 22, 11, and 8 months, respectively. For children with anaplastic astrocytoma (WHO grade III), median survival was 12 months, compared with 7 months for those with glioblastoma multiforme (WHO grade IV). This study did not find a statistically significant relationship between sex, race, presence of radiation therapy or extent of surgical resection and mortality.
  
  
  CONCLUSIONS
  Survival in primary pediatric high-grade spinal cord astrocytomas was positively associated with younger age and lower tumor grade. Survival was not associated with other demographic or treatment modality factors.
authors.affiliation: Section of Neurosurgery, Department of Surgery, University of Chicago, Chicago, IL 60637, USA. slam@surgery.bsd.uchicago.edu
authors.forename: Sandi
authors.initials: S
authors.lastname: Lam
authors.forename: Yimo
authors.initials: Y
authors.lastname: Lin
authors.forename: Stephanie
authors.initials: S
authors.lastname: Melkonian
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001254:Astrocytoma / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D012042:Registries; D012307:Risk Factors; D013120:Spinal Cord Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology