Diagnosis and outcomes of pediatric central nervous system tumors in China: a single-center retrospective analysis from 2015 to 2020

Abstract

Background: A primary central nervous system (CNS) tumor is the most common solid tumor among children, but few systematic and comprehensive studies on childhood CNS tumors in China. We aim to review the characteristics, treatments, and prognosis of childhood CNS tumors in a single-center and disclose the present issues on these tumors. Methods: The cross-sectional retrospective study analyzed patients with primary CNS tumors who were under 18 years old at Zhujiang Hospital, Southern Medical University (Guangzhou, China), from 2015 to 2020. Demographics, tumor types, localizations, histological characteristics, treatment strategies, and outcomes were assessed. Data were performed in descriptive statistics (means, ranges and 95% confidence intervals), and survival analysis was estimated based on the Kaplan-Meier method using SPSS Statistics 21.0 (IBM Corp., Armonk, NY, USA). Results: There were 445 patients screened and 431 patients enrolled in this study. The median age was 7 years old (ranging from 14 days to 18 years old), and the male to female ratio was 1.71 (272:159). The locations of CNS tumors consisted of supratentorial (n=261, 60.56%), infratentorial (n=143, 33.18%), and spinal cord (n=27, 6.26%). The major types of CNS tumors were glioma (n=102), medulloblastoma (n=57), hemangioma (n=34), ependymoma (n=30), nongerminomatous germ cell tumors (n=27), germinoma (n=24), and craniopharyngioma (n=14). The rate of surgery was 83.99% (n=362) and that of radiotherapy/ chemotherapy alone was 4.64% (n=20). Seventy-five patients (17.40%) discontinued or refused parts of their treatment, and 49 patients (11.37%) abandoned treatments on tumor. There were 308 patients (71.46%) alive, 82 (19.03%) dead, and 41 patients (9.51%) who were not available for follow-up by the end of the study. The 5-year survival rate of low-grade glioma (LGG), medulloblastoma, other embryonal tumors, ependymoma (World Health Organization grade III), germinoma, nongerminomatous germ cell tumors was 82.7%, 56.5%, 58.4%, 73.8%, 100.0%, and 53.8%, respectively. The 3-year survival rate of highgrade glioma (HGG) and ependymoma (World Health Organization grade I-II) was 22.0% and 82.1%, respectively. Conclusions: The study partly reflected the current situation of Chinese children with CNS tumors from a tertiary hospital. The high proportion of treatment refusal and abandonment, and the poor outcomes of patients with CNS tumors, show that it need more effort to improve the prognosis in the future.