Outcome and Prognostic Features in Pediatric Gliomas A Review of 6212 Cases From the Surveillance, Epidemiology, and End Results Database

BACKGROUND: Pediatric gliomas are rare and heterogeneous tumors. The Surveillance, Epidemiology, and End Results (SEER) database allows a large-scale analysis of the clinical characteristics and prognostic features of these tumors. METHODS: The authors analyzed available SEER data on 6212 patients younger than 20 years at diagnosis of glioma (1973-2005), according to 4 age categories: <1 year, 1-3 years, 3-5 years, and 5-20 years. RESULTS: The overall 5- and 10-year survival estimates were 71% +/- 0.62% (standard error) and 68% +/- 0.67%, respectively. Forty-one percent of gliomas were cerebral; the frequency of cerebellar tumors (22%-32% of gliomas) increased sharply after the first year of life. Of the tumors for which grade was available, 77% were low grade (grade I or II). Tumor grade emerged as the most significant independent prognostic factor in all age groups except the youngest age group, in which extent of resection was most significant. Surgery other than gross total resection was an adverse prognostic factor (hazard ratio, 2.18; 95% confidence interval, 1.78-2.67). Age <3 years predicted a greater likelihood of survival in patients with high-grade gliomas and brainstem tumors. Conversely, age <3 years predicted a lower likelihood of survival in patients with low-grade gliomas. Children aged <1 year received less radiotherapy than older patients (P < .0001) and were less likely to undergo gross total resection (P < .0001). CONCLUSIONS: The survival of children with gliomas is influenced by histologic subtype, age, and extent of resection. Despite its limitations, the SEER database provides a useful tool for studies of rare tumors such as pediatric gliomas. Cancer 2009;115:5761-70. (C) 2009 American Cancer Society.