Association between supratentorial pediatric high-grade gliomas involved with the subventricular zone and decreased survival: a multi-institutional retrospective study

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  • 1 Department of Neurological Surgery, Vanderbilt University Medical Center;
  • 2 School of Medicine, Vanderbilt University, Nashville, Tennessee;
  • 3 School of Medicine, Washington University, St. Louis, Missouri;
  • 4 Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis;
  • 5 Medical Scientist Training Program, School of Medicine, Vanderbilt University, Nashville;
  • 6 Vanderbilt Children’s Hospital, Nashville, Tennessee; and
  • 7 Department of Neurosurgery, Washington University, St. Louis, Missouri
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OBJECTIVE

The subventricular zone (SVZ), housed in the lateral walls of the lateral ventricles, is the largest neurogenic niche in the brain. In adults, high-grade gliomas in contact or involved with the SVZ are associated with decreased survival. Whether this association holds true in the pediatric population remains unexplored. To address this gap in knowledge, the authors conducted this retrospective study in a pediatric population with high-grade gliomas treated at three comprehensive centers in the United States.

METHODS

The authors retrospectively identified 63 patients, age ≤ 21 years, with supratentorial WHO grade III–IV gliomas treated at three academic centers. Basic demographic and clinical data regarding presenting signs and symptoms and common treatment variables were obtained. Preoperative MRI studies were evaluated to assess SVZ contact by tumor and to quantify tumor volume.

RESULTS

Sixty-three patients, including 34 males (54%), had a median age of 12.3 years (IQR 6.50–16.2) and a median tumor volume of 39.4 ml (IQR 19.4–65.8). Tumors contacting the SVZ (SVZ+) were noted in 34 patients (54%) and overall were larger than those not in contact with the SVZ (SVZ−; 51.1 vs 27.3, p = 0.002). The SVZ+ tumors were also associated with decreased survival. However, age, tumor volume, tumor grade, and treatment with chemotherapy and/or radiation were not associated with survival in the 63 patients. In the univariable analysis, near-total resection, gross-total resection, and seizure presentation were associated with increased survival (HR = 0.23, 95% CI 0.06–0.88, p = 0.03; HR = 0.26, 95% CI 0.09–0.74, p = 0.01; and HR = 0.46, 95% CI 0.22–0.97, p = 0.04, respectively). In a multivariable stepwise Cox regression analysis, only SVZ+ tumors remained significantly associated with decreased survival (HR = 1.94, 95% CI 1.03–3.64, p = 0.04).

CONCLUSIONS

High-grade glioma contact with the SVZ neural stem cell niche was associated with a significant decrease in survival in the pediatric population, as it is in the adult population. This result suggests that tumor contact with the SVZ is a general negative prognosticator in high-grade glioma independent of age group and invites biological investigations to understand the SVZ’s role in glioma pathobiology.

ABBREVIATIONS GBM = glioblastoma; HGG = high-grade glioma; SVZ = subventricular zone.

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Contributor Notes

Correspondence Akshitkumar M. Mistry: Vanderbilt University Medical Center, Nashville, TN. axitamm@gmail.com.

INCLUDE WHEN CITING Published online May 22, 2020; DOI: 10.3171/2020.3.PEDS19593.

Disclosures Dr. Limbrick receives research funding for unrelated projects from Microbot Medical Inc. and Medtronic Inc.

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