@article{2998451,
    title = "Incidence, time trends and survival patterns of childhood pilocytic astrocytomas in Southern-Eastern Europe and SEER, US",
    author = "Georgakis, M.K. and Karalexi, M.A. and Kalogirou, E.I. and Ryzhov, A. and Zborovskaya, A. and Dimitrova, N. and Eser, S. and Antunes, L. and Sekerija, M. and Zagar, T. and Bastos, J. and Agius, D. and Florea, M. and Coza, D. and Bouka, E. and Bourgioti, C. and Dana, H. and Hatzipantelis, E. and Moschovi, M. and Papadopoulos, S. and Sfakianos, G. and Papakonstantinou, E. and Polychronopoulou, S. and Sgouros, S. and Stefanaki, K. and Stiakaki, E. and Strantzia, K. and Zountsas, B. and Pourtsidis, A. and Patsouris, E. and Petridou, E.T.",
    journal = "Journal of Neuro-Oncology",
    year = "2017",
    volume = "131",
    number = "1",
    pages = "163-175",
    publisher = "Springer New York LLC",
    issn = "0167-594X",
    doi = "10.1007/s11060-016-2284-9",
    keywords = "adolescent;  age;  Article;  cancer incidence;  cancer prognosis;  cancer registry;  cancer survival;  cerebellum;  child;  clinical feature;  controlled study;  Eastern Europe;  female;  gender;  geographic distribution;  health care disparity;  human;  major clinical study;  male;  onset age;  pilocytic astrocytoma;  rural area;  Southern Europe;  standardized incidence ratio;  survival time;  tumor localization;  United States;  urbanization;  age distribution;  astrocytoma;  central nervous system tumor;  Europe;  follow up;  incidence;  infant;  Kaplan Meier method;  mortality;  preschool child;  proportional hazards model;  register;  time factor, Adolescent;  Age Distribution;  Age Factors;  Astrocytoma;  Central Nervous System Neoplasms;  Child;  Child, Preschool;  Europe;  Europe, Eastern;  Female;  Follow-Up Studies;  Humans;  Incidence;  Infant;  Kaplan-Meier Estimate;  Male;  Proportional Hazards Models;  Registries;  Time Factors;  United States",
    abstract = "Pilocytic astrocytomas (PA) comprise the most common childhood central nervous system (CNS) tumor. Exploiting registry-based data from Southern and Eastern Europe (SEE) and SEER, US, we opted to examine incidence, time trends, survival and tentative outcome disparities of childhood PA by sociodemographic and clinical features. Childhood PA were retrieved from 12 SEE registries (N = 552; 1983–2014) and SEER (N = 2723; 1973–2012). Age-standardized incidence rates (ASR) were estimated and survival was examined via Kaplan–Meier and Cox regression analysis. ASR of childhood PA during 1990–2012 in SEE was 4.2/106, doubling in the USA (8.2/106). Increasing trends, more prominent during earlier registration years, were recorded in both areas (SEE: +4.1 %, USA: +4.6 %, annually). Cerebellum comprised the most common location, apart from infants in whom supratentorial locations prevailed. Age at diagnosis was 1 year earlier in SEE, whereas 10-year survival was 87 % in SEE and 96 % in SEER, improving over time. Significant outcome predictors were age <1 year at diagnosis diagnosis (hazard ratio, HR [95% confidence intervals]: 3.96, [2.28–6.90]), female gender (HR: 1.38, [1.01–1.88]), residence in SEE (HR: 4.07, [2.95–5.61]) and rural areas (HR: 2.23, [1.53–3.27]), whereas non-cerebellar locations were associated with a 9- to 12-fold increase in risk of death. The first comprehensive overview of childhood PA epidemiology showed survival gains but also outcome discrepancies by geographical region and urbanization pointing to healthcare inequalities. The worse prognosis of infants and, possibly, females merits further consideration, as it might point to treatment adjustment needs, whereas expansion of systematic registration will allow interpretation of incidence variations. © 2016, Springer Science+Business Media New York."
}