Pilocytic astrocytoma: An NCDB analysis of contemporary clinical and socioeconomic patterns.

Abstract

e14082 Background: Pilocytic astrocytoma (PA) is a rare, low grade glioma, most commonly found in the cerebellum of pediatric and young adult patients. PA is histologically characterized by biphasic astrocytes with pilocytic morphology. Prognosis is favorable, with prior studies demonstrating a 10-year survival rate of 95% following gross total surgical resection. Given the rarity of PA, large-scale population-level data describing contemporary trends remain limited. This study addresses this gap by analyzing a substantially larger cohort of PA patients from the National Cancer Database (NCDB) with data extending through 2020 to better characterize contemporary clinical, socioeconomic, and demographic trends in PA patients. Methods: A retrospective cohort study was performed using the 2004-2020 NCDB to identify patients with histologically confirmed PA (ICD-O-3 Code: 9421). Demographic variables, including sex, race, Hispanic origin, insurance status, median household income, treatment facility type and location, and year of diagnosis, were analyzed through descriptive statistics. Incidence trends were determined via regression analysis. Results: This study identified 10,653 PA patients, with a stable annual incidence from 2004 to 2020 (R² = 0.10). Mean age at diagnosis was 20.6 years (IQR: 22). The cohort showed a slight male predominance (51.6%) and most patients were White (81.0%) and non-Hispanic (85.2%). A plurality were found in the highest income quartile (>$74,063; 36.6%). Most were privately insured (62.3%), followed by Medicaid (24.3%) and Medicare (4.9%). Nearly half (49.4%) of the patients resided in metropolitan areas with populations >1 million. Treatment was common at academic or research programs (54.4%), followed by community cancer programs (24.5%). A majority of patients (88.2%) had no comorbidities, demonstrated by a Charlson–Deyo score of 0. Clinically, the cerebellum was the most common primary tumor site (28.3%). Surgical resection was performed in 87.0% of cases and 78.8% of patients survived ≥ 90 days postoperatively. Primary radiation and primary chemotherapy were administered in 11.5% and 11.4% of patients, respectively. Mean tumor size was 39.2 mm (SD: 30.1). Two, five, and ten year survival rates were 96%, 92%, and 88%, respectively. Mean overall survival was 16 years (95% CI: 15.9–16.2). Conclusions: This study provides updated population-level data on contemporary clinical and sociodemographic trends in PA, addressing an existing gap in literature. Most patients were White, privately insured, resided in high-income metropolitan areas, and were treated at academic centers. The cerebellum was the most common primary site and long-term survival was favorable, consistent with prior studies. Additional population-level analyses incorporating more diverse sociodemographic data are needed to further validate these prognostic influences in PA patients.