INTRODUCTION Surgical resection of high-grade brainstem gliomas is challenging and treatment mostly involves radiation and chemotherapy. In this study, we utilized registry data to determine prognostic features and impact of chemotherapy and radiation on overall survival. METHODS The National Cancer Database was queried from 2006 to 2015 for adult cases with histologically confirmed high-grade brainstem glioma. Covariates including patient demographics, comorbidities, tumor characteristics and treatment parameters were captured. Multivariable Cox proportional hazards regression was performed to identify predictors of survival. RESULTS A total of 422 patients were analyzed. Most patients (66.6%) underwent postoperative radiation with chemotherapy, 9.2% underwent radiation alone, while the remaining had no postoperative treatment (24.2%). Overall median survival was 9.8 months (95% CI 8.8-12). Survival was longer (p < 0.001) in the radiation + chemotherapy group (median: 14.2 months, 95% CI 11.7-17.1) compared to radiation alone (median: 5.7 months, 95% CI 3.7-12) and no postoperative treatment (median: 1.8 months, 95% CI 1.4-4) groups. In multivariable analysis, increasing age was associated with worse survival (HR: 1.87, 95% CI 1.47-2.37, p < 0.001), whereas radiation + chemotherapy was associated with lower mortality compared to radiation alone (HR: 0.67, 95% CI 0.46-0.98, p = 0.038). In subgroup analysis, postoperative chemotherapy with radiation was associated with significant survival benefit compared to radiation alone for grade IV (HR: 0.46, 95% CI 0.28-0.76, p = 0.003), but not for grade III tumors (HR: 0.87, 95% CI 0.48-1.58, p = 0.65). CONCLUSION Analysis from a national registry illustrated the effectiveness of radiation with chemotherapy for adult patients with high-grade brainstem gliomas, particularly grade IV. Further research should identify specific patient profiles and molecular subgroups that are more likely to benefit from multimodality therapy.

中文翻译：

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放射和化学疗法在成年高级别脑干神经胶质瘤患者中的作用：国家癌症数据库的结果。

引言高度​​脑干神经胶质瘤的手术切除具有挑战性，治疗主要涉及放疗和化疗。在这项研究中，我们利用注册表数据来确定预后特征以及化疗和放疗对总体生存的影响。方法从2006年至2015年，查询国家癌症数据库中经组织学证实为高级脑干神经胶质瘤的成年病例。捕获了包括患者人口统计学，合并症，肿瘤特征和治疗参数在内的协变量。进行多变量Cox比例风险回归以识别生存预测因素。结果共分析了422例患者。大多数患者（66.6％）接受了化疗后的放疗，仅9.2％接受了放疗，其余患者未接受术后治疗（24.2％）。总体中位生存期为9.8个月（95％CI 8.8-12）。放疗+化疗组（中位数：14.2个月，95％CI 11.7-17.1）的生存期比单独放疗（中位数：5.7个月，95％CI 3.7-12）和没有术后治疗（中位数）的生存期更长（p <0.001）。 ：1.8个月，95％CI 1.4-4）组。在多变量分析中，年龄增加与较差的生存率相关（HR：1.87，95％CI 1.47-2.37，p <0.001），而放疗+化疗与单独放疗相比死亡率较低（HR：0.67，95％CI 0.46） -0.98，p = 0.038）。在亚组分析中，与单纯放疗相比，IV级患者术后放化疗具有显着的生存获益（HR：0.46，95％CI 0.28-0.76，p = 0.003），但对于III级肿瘤则无统计学意义（HR：0.87，95） ％CI 0.48-1.58，p ＝ 0.65）。结论从国家注册中心进行的分析表明，放化疗对成年高级脑干神经胶质瘤，尤其是四级脑胶质瘤患者的有效性。进一步的研究应确定更可能受益于多模式疗法的特定患者概况和分子亚组。