Clinical predictors of survival for patients with atypical teratoid/rhabdoid tumors.

Abstract

Atypical teratoid/rhabdoid tumors (AT/RTs) are malignant central nervous system (CNS) neoplasms of the young. Our study analyzed a large AT/RT cohort from the National Cancer Database (NCDB) to elucidate predictors of short-term mortality and overall survival (OS). Information was collected on patients with histologically confirmed AT/RT using the NCDB (2004-2016). Kaplan-Meier analysis indicated OS. Prognostic factors for 30-day mortality, 90-day mortality, and OS were determined via multivariate Cox proportional hazards (CPH) and logistic regression models. Our cohort of 189 patients had a median age of 1year (IQR [1, 4]) and tumor size of 4.7 ± 2.0cm at diagnosis. Seventy-two percent were under 3years old; 55.6% were male and 71.0% were Caucasian. Fifty (27.2%) patients received only surgery (S) (OS = 5.91months), 51 (27.7%) received surgery and chemotherapy (S + CT) (OS = 11.2months), and 9 (4.89%) received surgery and radiotherapy (S + RT) (OS = 10.3months). Forty-five (24.5%) received S + CT + RT combination therapy (OS = 45.4months), 13 (17.1%) received S + CT + BMT/SCT (bone marrow or stem cell transplant) (OS = 55.5months), and 16 (8.70%) received S + CT + RT + BMT/SCT (OS = 68.4months). Bivariate analysis of dichotomized age (HR = 0.550, 95% CI [0.357, 0.847], p = 0.0067) demonstrated significantly increased patient survival if diagnosed at or above 1year old. On multivariate analysis, administration of S + CT + RT, S + CT + BMT/SCT, or S + CT + RT + BMT/SCT combination therapy predicted significantly (p < 0.05) increased OS compared to surgery alone. AT/RTs are CNS tumors where those diagnosed under 1year old have a significantly worse prognosis. Our study demonstrates that while traditional CT, RT, and BMT/SCT combination regimens prolong life, overall survival in this population is still low.