title: Analysis of survival in pediatric high-grade brainstem gliomas: A population-based study.
abstract: BACKGROUND
  The purpose of this study was to use the National Cancer Institutes' Surveillance, Epidemiology, and End Results (SEER) database to perform a large-scale analysis of brainstem anaplastic astrocytoma (AA) and glioblastoma multiforme (GBM). Use of the SEER database gave us a larger sample size of this rare tumor type, allowing for the analysis of the relationship between prognostic factors and survival.
  
  
  METHODS
  We selected pediatric patients (<18 years old) from the SEER database with histologically confirmed diagnoses of primary high-grade gliomas (World Health Organization Grade III/IV) of the brainstem. In univariate and multivariate analysis, we analyzed the relationship between demographic (age, gender, race, diagnosis date), histologic (AA, GBM), and treatment (surgery, radiation) factors on survival.
  
  
  RESULTS
  In our cohort of 124 patients, those with AA had a median survival of 13 months and those with GBM 9 months. Higher-grade tumors were associated with statistically significantly increased mortality (hazard ratio [HR]: 1.74, confidence intervals [CIs]: 1.17-2.60). Surgical intervention was associated with a significantly lower mortality, either alone (HR: 0.14, CI: 0.04-0.5) or in combination with radiation (HR: 0.35, CI: 0.15-0.82). Radiation therapy alone was significantly associated with decreased mortality within the first 9 months after diagnosis but not with overall mortality. No demographic characteristics were significantly associated with mortality.
  
  
  CONCLUSIONS
  Outcome remains poor in the pediatric high-grade brainstem glioma population. Survival is correlated with lower-grade tumor histology, radiation therapy only in the first 9 months after diagnosis, and surgical resection.
authors.affiliation: Department of Neurosurgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Sandi
authors.initials: S
authors.lastname: Lam
authors.affiliation: Department of Neurosurgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Yimo
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Brenda
authors.initials: B
authors.lastname: Auffinger
authors.affiliation: Department of Cancer Epidemiology, MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Melkonian
keywords: Anaplastic astrocytoma; SEER; brainstem tumor; glioblastoma; population-based outcomes study