title: Incidence, time trends and survival patterns of childhood pilocytic astrocytomas in Southern-Eastern Europe and SEER, US.
abstract: Pilocytic astrocytomas (PA) comprise the most common childhood central nervous system (CNS) tumor. Exploiting registry-based data from Southern and Eastern Europe (SEE) and SEER, US, we opted to examine incidence, time trends, survival and tentative outcome disparities of childhood PA by sociodemographic and clinical features. Childhood PA were retrieved from 12 SEE registries (N = 552; 1983-2014) and SEER (N = 2723; 1973-2012). Age-standardized incidence rates (ASR) were estimated and survival was examined via Kaplan-Meier and Cox regression analysis. ASR of childhood PA during 1990-2012 in SEE was 4.2/106, doubling in the USA (8.2/106). Increasing trends, more prominent during earlier registration years, were recorded in both areas (SEE: +4.1 %, USA: +4.6 %, annually). Cerebellum comprised the most common location, apart from infants in whom supratentorial locations prevailed. Age at diagnosis was 1 year earlier in SEE, whereas 10-year survival was 87 % in SEE and 96 % in SEER, improving over time. Significant outcome predictors were age <1 year at diagnosis diagnosis (hazard ratio, HR [95% confidence intervals]: 3.96, [2.28-6.90]), female gender (HR: 1.38, [1.01-1.88]), residence in SEE (HR: 4.07, [2.95-5.61]) and rural areas (HR: 2.23, [1.53-3.27]), whereas non-cerebellar locations were associated with a 9- to 12-fold increase in risk of death. The first comprehensive overview of childhood PA epidemiology showed survival gains but also outcome discrepancies by geographical region and urbanization pointing to healthcare inequalities. The worse prognosis of infants and, possibly, females merits further consideration, as it might point to treatment adjustment needs, whereas expansion of systematic registration will allow interpretation of incidence variations.
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, 11527, Athens, Greece.
authors.forename: Marios K
authors.initials: MK
authors.lastname: Georgakis
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, 11527, Athens, Greece.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Karalexi
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, 11527, Athens, Greece.
authors.forename: Eleni I
authors.initials: EI
authors.lastname: Kalogirou
authors.affiliation: National Cancer Registry of Ukraine, National Institute of Cancer, Lomonosova str 33/43, Kyiv, 03022, Ukraine.
authors.forename: Anton
authors.initials: A
authors.lastname: Ryzhov
authors.affiliation: Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Childhood Cancer Subregistry of Belarus, Lesnoe-2, 223040, Minsk, Belarus.
authors.forename: Anna
authors.initials: A
authors.lastname: Zborovskaya
authors.affiliation: Bulgarian National Cancer Registry, National Oncology Hospital, 6 Plovdivsko Pole Street, 1756, Sofia, Bulgaria.
authors.forename: Nadya
authors.initials: N
authors.lastname: Dimitrova
authors.affiliation: Izmir Cancer Registry, Izmir Hub, Izmir & Hacettepe University Institute of Public Health, Zubeyde Hanim Caddesi No: 100, Karsiyaka, 35067, Izmir, Turkey.
authors.forename: Sultan
authors.initials: S
authors.lastname: Eser
authors.affiliation: North Region Cancer Registry of Portugal (RORENO), Portuguese Oncology Institute of Porto, Rua António Bernardino da Almeida, 4200-072, Porto, Portugal.
authors.forename: Luis
authors.initials: L
authors.lastname: Antunes
authors.affiliation: Croatian National Cancer Registry, Croatian Institute of Public Health, Rockefellerova 7, 10000, Zagreb, Croatia.
authors.forename: Mario
authors.initials: M
authors.lastname: Sekerija
authors.affiliation: Cancer Registry of Republic of Slovenia, Institute of Oncology, Zaloška cesta 2, 1000, Ljubljana, Slovenia.
authors.forename: Tina
authors.initials: T
authors.lastname: Zagar
authors.affiliation: Central Region Cancer Registry of Portugal (ROR-Centro), Portuguese Oncology Institute of Coimbra, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Bastos
authors.affiliation: Department of Health Information and Research, Malta National Cancer Registry, 95 Guardamangia Hill, Guardamangia, MSD 08, Malta.
authors.forename: Domenic
authors.initials: D
authors.lastname: Agius
authors.affiliation: Regional Cancer Registry of Iasi, National Institute of Public Health, 14 Victor Babes Street, 700465, Iasi, Romania.
authors.forename: Margareta
authors.initials: M
authors.lastname: Florea
authors.affiliation: Regional Cancer Registry of Cluj, Oncological Institute "Ion Chiricuta", Republicii Str no. 34-36, 400015, Cluj Napoca, Romania.
authors.forename: Daniela
authors.initials: D
authors.lastname: Coza
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, 11527, Athens, Greece.
authors.forename: Evdoxia
authors.initials: E
authors.lastname: Bouka
authors.affiliation: First Department of Radiology, Aretaieion Hospital, Medical School, University of Athens, Vasilissis Sofias Str. 76, 11528, Athens, Greece.
authors.forename: Charis
authors.initials: C
authors.lastname: Bourgioti
authors.affiliation: Oncology Department, "Mitera" Childrens Hospital, Erythrou Stavrou 15, 15123, Marousi, Athens, Greece.
authors.forename: Helen
authors.initials: H
authors.lastname: Dana
authors.affiliation: Second Department of Pediatrics, AHEPA General Hospital, Aristotelion University of Thessaloniki, Kiriakidi 1, 54621, Thessaloniki, Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Hatzipantelis
authors.affiliation: Haematology-Oncology Unit, First Department of Pediatrics, Athens University Medical School, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Moschovi
authors.affiliation: Department of Pathology, Hygeia Hospital, Erythrou Stavrou 6, 15123, Marousi, Athens, Greece.
authors.forename: Savvas
authors.initials: S
authors.lastname: Papadopoulos
authors.affiliation: Department of Neurosurgery, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Sfakianos
authors.affiliation: Department of Pediatric Hematology and Oncology, Hippokration Hospital, Konstantinoupoleos 49, 54642, Thessaloniki, Greece.
authors.forename: Evgenia
authors.initials: E
authors.lastname: Papakonstantinou
authors.affiliation: Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Polychronopoulou
authors.affiliation: Department of Neurosurgery, "Mitera" Childrens Hospital, Erythrou Stavrou 15, 15123, Marousi, Athens, Greece.
authors.forename: Spyros
authors.initials: S
authors.lastname: Sgouros
authors.affiliation: Histopathology Department, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Stefanaki
authors.affiliation: Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, University of Crete, Panepistimiou, 71500, Heraklion, Greece.
authors.forename: Eftichia
authors.initials: E
authors.lastname: Stiakaki
authors.affiliation: Histopathology Department, "Pan. & Agl. Kyriakou" Children's Hospital, Thivon 18, 11527, Athens, Greece.
authors.forename: Katerina
authors.initials: K
authors.lastname: Strantzia
authors.affiliation: Department of Neurosurgery, St. Luke's Hospital, Panorama, 55236, Thessaloniki, Greece.
authors.forename: Basilios
authors.initials: B
authors.lastname: Zountsas
authors.affiliation: Department of Pediatric Hematology-Oncology, "Pan. & Agl. Kyriakou" Children's Hospital, Thivon 18, 11527, Athens, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Pourtsidis
authors.affiliation: Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527, Athens, Greece.
authors.forename: Eustratios
authors.initials: E
authors.lastname: Patsouris
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, 11527, Athens, Greece. epetrid@med.uoa.gr.
authors.forename: Eleni Th
authors.initials: ET
authors.lastname: Petridou
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000367:Age Factors; D001254:Astrocytoma / Q000453:epidemiology* / Q000401:mortality*; D016543:Central Nervous System Neoplasms / Q000453:epidemiology* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012042:Registries; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: CNS tumors; Cancer registries; Childhood; Incidence; Pilocytic astrocytomas; Survival