The Epidemiological Characteristics and Prognostic Factors of Low-Grade Brainstem Glioma: A Real-World Study of Pediatric and Adult Patients
The Epidemiological Characteristics and Prognostic Factors of Low-Grade Brainstem Glioma: A Real-World Study of Pediatric and Adult Patients
复制标题
低度脑干胶质瘤的流行病学特征和预后因素：针对儿童和成人患者的真实世界研究。
DOI：
10.3389/fonc.2020.00391
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发表时间：
2020-04-09
影响因子：
4.7
通讯作者：
Chong, Quan
中科院分区：
文献类型：
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作者：
Liu, Zhuoyi;Feng, Songshan;Chong, Quan
目的：我们目前对低级别脑干胶质瘤（LGBSG）的认识仍然有限。本研究旨在进行一项大规模的基于人群的真实世界的研究，以了解LGBSG的流行病学特征，并确定癌症特异性生存期（CSS）和总生存期（OS）的LGBSG patients.Patients和方法的预测因素：我们使用监测流行病学和最终结果数据库进行这项研究的患者与组织学确诊的LGBSG。比较儿童和成人患者的人口统计学资料、肿瘤特征和治疗选择。单因素和多因素分析CSS和OS的预后因素，Kaplan-Meier曲线和决策树分析预后因素。通过L1惩罚（Lasso）回归进一步确定所有变量，然后建立诺模图预测5年和8年CSS和OS率。诺模图的精密度通过校准图、Harrell一致性指数和时间依赖性受试者工作特征曲线进行评价。结果：共分析了305例LGBSG患者，包括165例儿童和140例成人患者。成人和儿童患者在肿瘤大小、肿瘤扩展、辅助治疗和生存率方面表现出不同的模式。单因素分析显示，儿童组、大体全切除术（GTR）、世界卫生组织II级、放疗、扩展至脑室系统和弥漫性星形细胞和少突胶质细胞肿瘤（DAOT）与CSS显著相关。多因素分析显示，儿童组、转移、脑室系统受累和DAOT与CSS独立相关。Kaplan-Meier曲线和决策树分析进一步确定影响预后的因素。Kaplan-Meier曲线也显示辅助治疗对GTR和非GTR患者没有增加益处。此外，诺模图的开发和CSS的内部验证的C指数为0.87（95%CI，0.78-0.96）。结论：这项研究表明，儿童和成人患者有不同的肿瘤特性，治疗选择，和生存率。多因素分析显示，儿童组、DAOT、脑室系统受累和转移是CSS的独立预后因素。辅助治疗对GTR和非GTR患者的CSS没有益处。该列线图具有判别性和临床实用性。
Purpose: Our current understanding of low-grade brainstem glioma (LGBSG) is still limited. This study aimed to conduct a large-scale population-based real-world study to understand the epidemiological characteristics of LGBSG and determine the predictive factors of cancer-specific survival (CSS) and overall survival (OS) of LGBSG patients.Patients and Methods: We used Surveillance Epidemiology and End Results database to conduct this study of patients with histologically confirmed LGBSG. Patient demographics, tumor characteristics, and treatment options were compared between pediatric and adult patients. Univariate and multivariate analyses were employed to determine prognostic factors of CSS and OS. Kaplan-Meier curve and decision tree were used to confirm the prognostic factors. All variables were further identified by L1-penalized (Lasso) regression and then a nomogram was established to predict the 5- and 8-year CSS and OS rate. The precision of the nomogram was evaluated by calibration plots, Harrell's concordance index, and time-dependent receiver operating characteristic curve. The clinical use of nomogram was estimated by decision curve analysis.Results: A cohort of 305 patients with LGBSG, including 165 pediatric and 140 adult patients, was analyzed. Adult and pediatric patients showed different patterns concerning tumor size, tumor extension, adjuvant therapy, and survival rate. Univariate analysis revealed that pediatric group, gross total resection (GTR), World Health Organization grade II, radiotherapy, extension to ventricular system, and diffuse astrocytic and oligodendroglial tumor (DAOT) were significantly associated with CSS. Multivariate analysis showed that pediatric group, metastasis, ventricular system involvement, and DAOT were independently associated with CSS. The prognostic factors were further confirmed by Kaplan-Meier curve and decision tree. Kaplan-Meier curve also showed that adjuvant therapy added no benefits in patients with GTR and non-GTR. In addition, the nomogram was developed and the C-index of internal validation for CSS was 0.87 (95% CI, 0.78-0.96).Conclusion: This study shows that pediatric and adult patients have different tumor characteristics, treatment options, and survival rate. Pediatric group, DAOT, ventricular system involvement, and metastasis were identified as independent prognostic factors for CSS by multivariate analysis. Adjuvant therapy showed no benefits on CSS in patients with GTR and non-GTR. The nomogram was discriminative and clinically useful.