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Background Pleomorphic xanthoastrocytomas (PXA) are circumscribed gliomas that typically have a favorable prognosis. Limited studies have revealed factors affecting survival outcomes in PXA. Here, we analyzed the largest PXA dataset in the literature and identify factors associated with outcomes. Methods Using the Surveillance, Epidemiology, and End Results (SEER) 18 Registries database, we identified histologically confirmed PXA patients between 1994 and 2016. Overall survival (OS) was analyzed using Kaplan-Meier survival and multivariable Cox proportional hazard models. Results In total, 470 patients were diagnosed with PXA (males = 53%; median age = 23 years [14-39 years]), the majority were Caucasian (n = 367; 78%). The estimated mean OS was 193 months [95% CI: 179-206]. Multivariate analysis revealed that greater age at diagnosis (≥39 years) (3.78 [2.16-6.59], P < .0001), larger tumor size (≥30 mm) (1.97 [1.05-3.71], P = .034), and postoperative radiotherapy (RT) (2.20 [1.31-3.69], P = .003) were independent predictors of poor OS. Pediatric PXA patients had improved survival outcomes compared to their adult counterparts, in which chemotherapy (CT) was associated with worse OS. Meanwhile, in adults, females and patients with temporal lobe tumors had an improved survival; conversely, tumor size ≥30 mm and postoperative RT were associated with poor OS. Conclusions In PXA, older age and larger tumor size at diagnosis are risk factors for poor OS, while pediatric patients have remarkably improved survival. Postoperative RT and CT appear to be ineffective treatment strategies while achieving GTR confer an improved survival in male patients and remains the cornerstone of treatment. These findings can help optimize PXA treatment while minimizing side effects. However, further studies of PXAs with molecular characterization are needed.

Background Treatment for glioblastoma (GBM) in elderly (age > 65 years) patients can be affected by multiple geographic and socioeconomic parameters. Correspondingly, the aim of this study was to determine trends in treatment of elderly GBM patients in the United States. Methods All GBM patients in the U.S. National Cancer Database between 2005 and 2016 were retrospectively reviewed. Status of treatment by triple therapy (resection, chemotherapy, and radiation) were summarized and analyzed by U.S. Census region. Results There were 44 338 GBM patients included, with 21 573 (49%) elderly and 22 765 (51%) nonelderly patients with median ages 72 years (range, 65-90 years) and 47 years (range, 40-64 years), respectively. Compared to nonelderly patients, elderly patients had significantly lower odds of being treated by triple therapy (odds ratio, OR = 0.54) as a whole, and its individual elements of resection (OR = 0.78), chemotherapy (OR = 0.46), radiation therapy (OR = 0.52). This was reflected in each U.S. Census region, with the lowest odds of being treated with triple therapy, surgical resection, chemotherapy, and radiation therapy in New England (OR = 0.51) Mountain (OR = 0.66), West North Central (OR = 0.38), and the Middle Atlantic (OR = 0.44), respectively. Multivariable analysis revealed multiple socioeconomic parameters that significantly predicted lower odds of triple therapy in the elderly. Conclusions In the United States alone, there exists geographic disparity in the treatment outcomes of elderly GBM patients. Multiple socioeconomic parameters can influence access to treatment modalities for elderly patients compared to younger patients in different geographic regions, and public health initiatives targeting these aspects may prove beneficial conceptually to optimize and homogenize clinical outcomes.