title: Sex, Age, Anatomic Location, and Extent of Resection Influence Outcomes in Children With High-grade Glioma.
abstract: BACKGROUND
  Survival duration and prognostic factors in adult high-grade glioma have been comprehensively analyzed, but less is known about factors contributing to overall survival (OS) and progression-free survival (PFS) in pediatric patients.
  
  
  OBJECTIVE
  To identify these factors in the pediatric population.
  
  
  METHODS
  We retrospectively reviewed institutional databases evaluating all patients ≤21 years with high-grade glioma treated between 1988 and 2010. Kaplan-Meier curves and log-rank statistics were used to compare groups univariately. Multivariate analyses were completed using Cox proportional hazards regression models.
  
  
  RESULTS
  Ninety-seven patients were identified with a median age of 11 years. Median OS was 1.7 years, and median PFS was 272 days. Location was significant for OS (P < .001). Patients with gross total resection (GTR) had a median OS of 3.4 years vs 1.6 years for subtotal resection and 1.3 years for biopsy patients (P < .001). Female patients had improved OS (P = .01). Female patients with GTR had a mean OS of 8.1 years vs 2.4 years for male patients with GTR and 1.4 years for all other female patients and male patients (P = .001). PFS favored patients ≤3 and ≥13 years and females (P = .003 and .001).
  
  
  CONCLUSIONS
  OS was significantly correlated with the location of the tumor and the extent of resection. GTR significantly improved overall survival for both glioblastoma multiforme and anaplastic astrocytoma patients, and female patients showed a much larger survival benefit from GTR than male patients.
authors.affiliation: *Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York; ‡Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York; §Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; ¶Children's Brain Tumor Project, New York, New York.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: McCrea
authors.forename: Evan D
authors.initials: ED
authors.lastname: Bander
authors.forename: Rachael A
authors.initials: RA
authors.lastname: Venn
authors.forename: Anne S
authors.initials: AS
authors.lastname: Reiner
authors.forename: J Bryan
authors.initials: JB
authors.lastname: Iorgulescu
authors.forename: Luis A
authors.initials: LA
authors.lastname: Puchi
authors.forename: Peter M
authors.initials: PM
authors.lastname: Schaefer
authors.forename: Gustav
authors.initials: G
authors.lastname: Cederquist
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Greenfield
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001921:Brain / Q000473:pathology / Q000601:surgery*; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome