Abstract
IntroductionPilocytic astrocytoma (PA) is the most common primary brain neoplasm in children and treated in curative intent with gross total resection (GTR). However, PA is rare in adults, resulting in limited knowledge on the natural clinical course. This study aimed to describe the clinical course and identify prognostic factors of adult patients with PA.Methods46 patients ≥ 18 years at diagnosis of PA and neurosurgical resection or biopsy between 2000 and 2018 were identified from the Neuro-Biobank of the Medical University of Vienna. In two cases with differing histopathological diagnosis at recurrence, DNA methylation analysis was performed using Illumina Infinium HumanMethylation850 BeadChip (850 k) arrays and the Molecular Neuropathology classifier. Clinico-pathological features were correlated with patient outcomes.ResultsMedian age at diagnosis was 32.5 years (range: 19–75) and median Ki67 proliferation index was 2.8% (0.5–13.4%). Tumor location significantly correlated with resectability (p < 0.001). Tumor progression or recurrence was observed in 9/46 (19.6%) patients after a median follow up time of 53.0 months (range 0.5–300). 5-year overall and progression-free survival rates were 85.3% and 70.0%, respectively. 2/9 (22.2%) patients presented with histological changes in the recurrent tumor specimen. In detail, methylation classification redefined the histological diagnosis to anaplastic astrocytoma with piloid features and glioma in one patient, each. Age > 40 and higher body mass index (BMI) were associated with impaired progression-free and overall survival (p < 0.05).ConclusionsTumor recurrence or progression in adult PA patients was higher than the one reported in pediatric patients. Higher age and BMI were associated with impaired prognosis.
Highlights
Pilocytic astrocytoma (PA) is the most common primary brain neoplasm in children and treated in curative intent with gross total resection (GTR)
We investigated the clinical characteristics in a relatively large cohort of adult PA patients and observed higher recurrence/progression rates in the adult population as compared to the previously reported ones in pediatric patients. Clinical factors such as higher age and higher body mass index (BMI) were associated with impaired prognosis in adult PA patients and may be useful in the prognostic assessment of adult PA patients
Our study provides further insights into the clinical course of PA in adults treated at a tertiary care center
Summary
Pilocytic astrocytoma (PA) is the most common primary brain neoplasm in children and treated in curative intent with gross total resection (GTR). This study aimed to describe the clinical course and identify prognostic factors of adult patients with PA. Age > 40 and higher body mass index (BMI) were associated with impaired progression-free and overall survival (p < 0.05). Conclusions Tumor recurrence or progression in adult PA patients was higher than the one reported in pediatric patients. Pilocytic astrocytomas (PA) occur with an age-adjusted incidence rate of 0.91/100,000 per year and are the most common primary central nervous system tumor in children and adolescents [1]. Gross total resection (GTR) is the main treatment approach to achieve cure in pediatric as well as adult patients. Only limited data on the prognostic assessment of adult PA patients exists, as most series were rather small and frequently did not include patients aged > 50 years. We aimed to analyze a broader pattern of clinical factors and the association with clinical course in a large adult PA cohort treated at a tertiary care center
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