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Comparison of the clinical features and treatment outcomes of pilocytic astrocytoma in pediatric and adult patients

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Abstract

Purpose

Pilocytic astrocytoma is a slow-growing tumor that predominantly develops in children, but has a broad age spectrum. A notable characteristic of pilocytic astrocytoma is that the tumor arises in diverse locations and the clinical course is not always benign. Therefore, it is necessary to elucidate the clinical spectrum of the disease and analyze the relevant prognostic factors.

Methods

Demographic and treatment-related factors were retrospectively reviewed in a cohort of 254 patients with histologically confirmed pilocytic astrocytoma. Clinical features were compared between the pediatric group (N = 208; age < 18 years) and the adult group (N = 46; age ≥ 18 years). Cox regression analysis was performed to identify relevant prognostic factors.

Results

There was no difference in progression-free survival (PFS) between the pediatric and adult groups (p = 0.36); however, patients under 8 years of age exhibited worse PFS (p < 0.01). Leptomeningeal seeding at diagnosis and pilomyxoid histology was observed only in pediatric patients. In the pediatric group, nine patients experienced recurrence after complete resection. Increasing age (hazard ratio (HR) = 0.89, p < 0.01) and adjuvant therapy (HR = 0.32, p < 0.01) were protective factors against tumor progression. In the adult group, no progression occurred after complete resection. Age and adjuvant therapy were not significant factors in the adult group.

Conclusion

Pilocytic astrocytoma presents with a diverse clinical spectrum. Complete resection is of utmost importance, and appropriate adjuvant treatment is recommended if complete resection cannot be achieved. Children with younger age are associated with more aggressive tumors, and recurrence may occur even after complete resection.

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Data availability

The dataset supporting the conclusions of this study is available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Funding

This research was supported by grants from the Creative-Pioneering Researchers Program through Seoul National University (800–20210571; to Phi JH).

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Author notes

  1. Ji Hoon Phi and Chul-Kee Park are equally responsible for this study.

Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea

    Joo Whan Kim, Ji Hoon Phi & Seung-Ki Kim

  2. Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

    Joo Ho Lee

  3. Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

    Sung-Hye Park & Jae-Kyung Won

  4. Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

    Jung Yoon Choi & Hyoung Jin Kang

  5. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea

    Chul-Kee Park

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  1. Joo Whan Kim
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Contributions

Ji Hoon Phi and Chul-Kee Park designed the study. Joo Ho Lee, Sung-Hye Park, Jae-Kyung Won, Jung Yoon Choi, and Hyoung Jin Kang collected the data. Joo Whan Kim and Ji Hoon Phi statistically analyzed the data and drafted the manuscript. Seung-Ki Kim, Sung-Hye Park, Jung Yoon Choi, Hyoung Jin Kang, and Chul-Kee Park read and approved the final version for publication. All authors significantly contributed to the content of the manuscript.

Corresponding authors

Correspondence to Ji Hoon Phi or Chul-Kee Park.

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Ethics approval and consent to participate

This study protocol was approved by the Institutional Review Board of our institute (IRB No. 2202–098-1301) and was conducted according to the Helsinki Declaration. The requirement for informed consent was waived by the Institutional Review Board of our institute, owing to the retrospective nature of the study.

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The waiver of consent was granted under IRB review.

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The authors declare no conflicts of interest.

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Kim, J.W., Phi, J.H., Kim, SK. et al. Comparison of the clinical features and treatment outcomes of pilocytic astrocytoma in pediatric and adult patients. Childs Nerv Syst 39, 583–591 (2023). https://doi.org/10.1007/s00381-023-05839-x

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  • DOI: https://doi.org/10.1007/s00381-023-05839-x

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