Radiotherapy Is Associated With Improved Overall Survival in Adult Pineoblastoma: A SEER Database Analysis

• Published in: World neurosurgery 2023-04, Vol.172, p.e312-e318
• Main Authors: Mehkri, Yusuf, Gendreau, Julian L., Fox, Keiko, Hameed, N.U. Farrukh, Jimenez, Miguel A., Mukherjee, Debraj
• Format: Article
• Language: English
• Subjects: Adult; Aged; Brain Neoplasms - radiotherapy; Brain Neoplasms - surgery; Female; Gross total resection; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Overall survival; Pineal Gland - surgery; Pinealoma - radiotherapy; Pinealoma - surgery; Pineoblastoma; Proportional Hazards Models; Radiotherapy; Radiotherapy, Adjuvant; SEER; SEER Program; Subtotal resection; Survival Analysis
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2023.01.014

Pineoblastomas (PBLs) are rare high-grade tumors treated variably with surgery and/or radiation. The role of surgical extent of resection and radiotherapy (RT) in adult PBL remains unclear. We queried the Surveillance, Epidemiology, and End Results (SEER) database to assess these variables' effects on overall survival (OS) in adult PBL. The SEER (1975–2016) database was queried for adult patients with diagnosis of PBL (ICD-0-3: 9362/3). Variables extracted included age, sex, race, geographical region, extent of tumor resection, RT, chemotherapy (CT), and OS data. Comparisons were performed with the χ2 test for categorical variables, Cox proportional hazards models to assess the association of clinical variables on OS, and Kaplan-Meier curves were generated. A total of 201 patients with PBL were identified with mean age 40.0 years (interquartile range 27.0–51.0) and most patients being male (53%) and Caucasian (77%). 101 (50%) patients received RT, and gross total resection was achieved in 83 (41%). Age stratification by decade revealed statistically significant poorer OS in patients aged ≥70 years. In bivariate analysis, RT with or without surgery was associated with improved 5-year OS compared with no RT (77.3% vs. 63.2%, P = 0.020). In multivariate analysis, age was a poor prognostic factor for OS (P < 0.001) and RT did appear to improve survival (P = 0.020). Extent of surgical resection was not significantly associated with improved survival. In adult patients with PBL, RT may offer an OS benefit irrespective of surgery or extent of surgical resection. Patients ≥70 years of age are associated with poorer OS.