Epidemiological characteristics and prognostic factors of high-grade brainstem glioma for all ages and the establishment of a nomogram.
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BACKGROUND: High-grade brainstem gliomas (HGBSGs) are aggressive tumors with dismal prognoses. Large-scale studies across all ages are needed to clarify their characteristics and identify predictors of cancer-specific mortality. This study sought to use data from the Surveillance Epidemiology and End Results (SEER) database to conduct a population-based analysis of HGBSG patients of all ages, identify factors influencing cancer-specific survival (CSS), and develop nomograms for prognostic prediction. METHODS: We retrospectively analyzed patients with pathologically confirmed brainstem high-grade gliomas using the SEER database from 2000 to 2018. Univariate and multivariate Cox regression, which included patient demographics, tumor characteristics, and treatments were used to identify risk factors that affected CSS in high-grade glioma patients of all ages. In addition, we evaluated nomograms that were developed using these patient cohorts. RESULTS: A total of 300 patients were selected for this study, which included 179 adults and 121 pediatric patients. The median survival time was longer in pediatric (11 months) than in adult patients (7 months; P=0.041). Multivariate analysis showed that anaplastic astrocytoma (AA) [hazard ratio (HR), 0.66; 95% confidence interval (CI): 0.50-0.89; P=0.006] and chemotherapy (HR, 0.57; 95% CI: 0.42-0.77; P<0.001) significantly increased patient's CSS. In contrast, being single (HR, 1.70; 95% CI: 1.08-2.66; P=0.02) significantly reduced patient's CSS. Multivariate analysis and Kaplan-Meier curves demonstrated that the extent of resection and radiotherapy (RT) were not independent factors that affected patient prognosis. CONCLUSIONS: Overall survival was poor. However, the survival time of pediatric patients was significantly longer compared to adult patients. In HGBSG patients, the extent of resection may not have a significant effect on prognosis. Chemotherapy was found to significantly improve patient prognosis. The effect of RT on patient prognosis requires further study.