Presenter(s)
J. D. Feyisa1, K. Austin2, and K. B. Pointer1; 1Dartmouth-Hitchcock Medical Center, Lebanon, NH, 2Hampton University, Hampton, VA
Purpose/Objective(s): Pleomorphic xanthoastrocytoma (PXA) is a rare WHO grade 2–3 astrocytic tumor that predominantly affects children and young adults, and about two-thirds harbor a BRAF V600E mutation. Although surgical resection is the primary treatment, formal guidelines for the multimodal management of PXA are lacking. The impact of demographic, socioeconomic, and treatment-related factors on overall survival (OS) remains unclear. We therefore aimed to identify prognostic drivers of survival and test the hypothesis that receipt of definitive therapy influences outcomes.
Materials/Methods: Data was gathered from the Surveillance, Epidemiology, and End Results (SEER) Database to understand prognostic factors impacting overall survival (OS) for patients with PXA. SEER data for patients coded as pleomorphic xanthoastrocytoma ( 9424/3) diagnosed between 2000 and 2022 was extracted. A total of 928 patients met inclusion criteria. Variables retrieved included age at diagnosis, race/ethnicity, tumor grade, laterality, tumor size, median household income (2023-adjusted), Rural-Urban Continuum Code, receipt of surgery, radiation, and systemic therapy, months from diagnosis to death or last follow-up, and vital-status. Survival analyses were performed in SPSS v28.0.1.1 and GraphPad Prism v10.6.0 using Kaplan-Meier curves and log-rank tests; variables with p < 0.05 were entered into univariate and multivariable Cox proportional-hazards models. One-way ANOVA examined the influence of demographic factors on treatment receipt, and significant ANOVA results were explored with post-hoc Tukey HSD tests.
Results: The median OS was 52 months with a median follow-up of 71 months. Univariate analysis identified older age, surgical resection, receipt of radiation, and receipt of systemic therapy as significant predictors of OS. In the multivariable Cox model, only surgical resection remained an independent favorable factor (adjusted HR = 0.58; 95 % CI = 0.41–0.82; p = 0.002) and older age remained an independent negative factor (adjusted HR per 10 yr = 1.29; 95 % CI = 1.12–1.48; p < 0.001). Radiation ( p = 0.12) and systemic therapy (p = 0.44) were no longer statistically significant.
Conclusion: PXA is a rare primary brain tumor that predominantly affects children and young adults. In this SEER-based cohort. Surgical resection is an independent predictor of prolonged survival in PXA, whereas older age is associated with poorer outcomes. Radiation and systemic therapy do not independently improve OS after adjustment for age and other covariates. The results underscore the need for prospective, guideline-driven studies to define optimal multimodal treatment strategies for this rare tumor.