Trends in paediatric central nervous system tumour incidence by global region from 1988 to 2012

Background Central nervous system (CNS) tumours comprise 20% of childhood cancers worldwide. Whether childhood CNS tumour incidence has increased over time across geographic regions remains to be explored. Methods We identified CNS cancers in the Cancer in Five Continents (CI5) data and estimated age standardized incidence rates (ASRs; cases/million children) and 95% confidence intervals (95% CI), male-to-female incidence rate ratios (IRR; 95% CI) and average annual percent change in incidence (AAPC; 95% CI) by geographic region for children aged 0–19 years where data were available using Poisson regression and generalized estimating equations (GEE). Cancers included: astrocytic tumours, medulloblastoma, ependymal, oligodendroglial and mixed glioma, glioma of uncertain origin, and other embryonal tumours. Geographic regions were defined using the United Nations geoscheme. Results There were 56 468 CNS cancers included in the study. ASRs were highest for astrocytic tumours globally in 2012 (ASR: 5.83; 95% CI: 5.68–5.99). Globally, all cancers exhibited a male excess in incidence. Regionally, only medulloblastoma had a consistently elevated male-to-female IRR at 1.4–2.2. Globally, incidence decreased for astrocytic tumours in GEE models (AAPC: −1.66; 95% CI: −3.04 to −0.26) and increased for medulloblastoma (AAPC 0.66; 95% CI: 0.19–1.14), ependymal tumours (AAPC: 1.49; 95% CI: 1.49; 95%: 0.69–2.30), glioma of uncertain origin (AAPC: 4.76; 95% CI: 1.17–1.14) and other embryonal tumours (AAPC: 3.58; 95% CI: 2.03–5.15). Regional variation in incidence trends was observed. Countries moving from lower to higher Human Development Index (HDI) over time did not appear to drive observed incidence trends. Conclusions Epidemiologic and molecular studies on underlying mechanisms for changes in the global incidence of CNS tumours are necessary.

Immunohistochemical Expression of Epidermal Growth Factor Receptor in Astrocytic Tumors in Iraqi Patients

BACKGROUND: Diffuse astrocytomas constitute the largest group of primary malignant human intracranial tumours. They are classified by the World Health Organization (WHO) into three histological malignancy grades: diffuse astrocytomas (grade II), anaplastic astrocytomas (grade III) and glioblastoma (grade IV) based on histopathological features such as cellular atypia, mitotic activity, necrosis and microvascular proliferation. Epidermal growth factor receptor (EGFR) is a 170-kDa transmembrane tyrosine kinase receptor expressed in a variety of normal and malignant cells regulating critical cellular processes. When activated, epidermal growth factor receptor (EGFR) triggers several signalling cascades leading to increased proliferation and angiogenesis and decreased apoptosis and hence associated with aggressive progression of the tumour. Epidermal growth factor receptor (EGFR) level is known to be a strong indicator associated with the aggressive behaviour of the tumour and acts as a prognostic factor for evaluating the survival rate. AIM: To evaluate the expression of epidermal growth factor receptor (EGFR) in different grades of astrocytoma. MATERIAL AND METHODS: formalin-fixed paraffin-embedded astrocytic tumours of 44 patients were collected from the archival material of pathology department of Ghazi Al Hariri Teaching Hospital during the period from June to December 2018. Hematoxylin and eosin-stained sections were used to characterise the tumours histologically based on cellularity, nuclear hyperchromasia, polymorphism, mitotic activity, vascular proliferation and necrosis with or without pseudopallisading of tumour cells. Diagnosis and grading of astrocytic tumours in this study were made according to WHO criteria (2016). Using a monoclonal antibody to the epidermal growth factor receptor (EGFR) and immunohistochemical analysis, the expression and distribution of epidermal growth factor receptor in astrocytic tumours were examined. RESULTS: The study included 1 case pilocytic astrocytoma (grade I), 20 cases diffuse astrocytoma (grade II), 5 cases anaplastic astrocytoma (grade III) and 18 cases of glioblastoma (grade IV). Expression of EGFR was found in 38.88% of the glioblastoma samples (grade IV). However, none of the astrocytomas of WHO grades I, II and III showed immunoreactivity for EGFR protein. Different patterns of immunoreactive cells and significant intratumor heterogeneity of EGFR expression were observed in glioblastomas. CONCLUSION: The immunohistochemical expression of Epidermal growth factor receptor (EGFR) was restricted only to high-grade astrocytic tumours, namely glioblastoma, thus may use to predict glioblastoma.

Global trends in survival from brain tumours in adolescents and young adults: a systematic review.

Background Brain tumours represent an important cause of cancer-related death in adolescents and young adults. Most are diagnosed in low-income and middle-income countries. We aimed to conduct the first systematic review of time trends and geographical variation in survival in this age group. Methods We included observational studies describing population-based survival from astrocytic tumours in patients aged 15-39 years. We queried six electronic databases from database inception to 30 September 2018. This review is registered with PROSPERO, number CRD42018111981. Results Among 5,245 retrieved records, 20 studies fulfilled the inclusion criteria. Only one study was partly conducted in middle-income countries. Five-year survival from astrocytoma (broad morphology group) varied between 48% and 71% (1973-2004), without clear trends or geographic differences. Adolescents with astrocytoma had better outcomes than young adults, but survival values were similar when non-malignant tumours were excluded. During 2002-2007, five-year survival for WHO grade I-II tumours was in the range 75-93% in England, Germany, and the US, but lower in South-Eastern Europe (59%). Five-year survival for anaplastic astrocytoma varied between 40% and 55% (2002-2007). Five-year survival from glioblastoma was in the range 15-23% (1991-2009). Conclusions Survival from astrocytic tumours remained somewhat steady over time, with little change between 1973 and 2009. Survival disparities were difficult to examine, because nearly all the studies were conducted in affluent countries. Studies often adopted the International Classification of Childhood Cancer, which, however, did not allow to accurately describe variation in survival. Larger studies are warranted, including under-represented populations and providing more recent survival estimates. Keywords Population-based survival, brain tumours, adolescents, young adults, time trends.

Spectrum of Central Nervous System Tumours in a Tertiary Hospital of Bangladesh

Background: Tumour registry data on intracranial and intraspinal tumours from a newly set up tertiary hospital of Bangladesh is presented here to provide substantial information about the current trends. Materials & methods: Hospital records of patients admitted under the neurosurgery service between January 2016 upto December 2017 were evaluated. Causes with a principal diagnosis of brain and spinal cord tumours were identified. Diagnosis with WHO grading and the histological subtypes are recorded. Results: 86 cases of various tumours were retrieved out of total 98 neurosurgical cases. 70 of these tumours were of intracranial origin and 16 of intraspinal origin. Male to female ratio was approximately 1.28:1. The mean age of the patients was 45.9 years (range 3-75 years). Paediatric and adult patients accounted for 12.6% and 87.4% respectively. Most of the tumours were found in the 6th decade. Paediatric intracranial tumours were predominately by medulloblastoma while adult population showed highest incidence of astrocytic tumours. Some rare entities were also encountered such as intracranial germinoma, Diffuse large B cell lymphoma (DLBCL) and squamous cell carcinoma in a pre-existing intracranial epidermoid cyst. Conclusions: Distribution of CNS tumour among this population gives a glimpse of the prevalence rate of such tumours in our community. This data can be linked to other national and international tumour registry for improved therapeutics and research. J MEDICINE JUL 2019; 20 (1) : 34-37