Pilocytic astrocytomas (PAs) are the most common brain tumors of childhood1 and can arise anywhere within the neuroaxis, including the posterior fossa (pf-PA), supratentorial midline (sm-PA; including optic pathway, hypothalamus, thalamus), supratentorial cortex (sc-PA), brainstem (bs-PA), and spinal cord (sp-PA). While tumor location (sm, bs) has been proposed as a prognostic factor associated with poor progression-free survival (PFS),2-4 this effect is abrogated when resection status (gross total resection [GTR], subtotal resection [STR]) is included.2,4 To determine whether tumor location has any value in predicting PA clinical outcome, we evaluated clinical outcomes of children with biopsy-proven PA treated at St. Louis Children's Hospital between 2003 and 2021 (n = 251). Subjects with a diagnosis of neurofibromatosis type 1 (NF1; n = 13) and those with discrepancies in their pathologic diagnosis (n = 11) or missing pertinent clinical data (n = 36) were excluded, leaving 191 total subjects for analysis. Consistent with prior reports,5 children with sc-PA were typically older at diagnosis than those with pf-PA. There were no differences in PA location incidence by sex,1 but individuals with sm-PA and bs-PA had higher rates of STR (Figure 1A) and reduced PFS (Figure 1B).2,3 Importantly, this difference in PFS was related to resection status, such that longer PFS was observed in sm-JPA and bs-JPA cases in which a GTR was achieved (Figure 1C).

Original languageEnglish
Article numbervdab187
JournalNeuro-Oncology Advances
Issue number1
StatePublished - Jan 1 2022


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