Protoplasmic astrocytoma: An analysis of demographic and socioeconomic factors

Background: Protoplasmic astrocytoma (PA) is an extremely rare subtype of astrocytoma composed of malignant cells similar to protoplasmic astrocytes. Although rare, the slow-growing course of PA can often delay diagnosis and treatment, worsening survival rates. Radiologically, PA’s tendency to mimic the presentation of other non-malignant diseases such as neurosarcoidosis and Wegener’s, resulting in further delay of diagnosis and treatment. Given the difficulty of diagnosing PA, valuable insights into PA’s epidemiology can be gleaned from diagnostic trends. Here, the demographic factors of protoplasmic astrocytoma were determined by analyzing data from the National Cancer Database (NCDB).

Methods: In this retrospective cohort analysis, demographic factors (age, sex, race, Hispanic status, insurance status, and Charles/Deyo score) of patients diagnosed with protoplasmic astrocytoma (N=61) were analyzed by descriptive statistics. This was done utilizing data from the 2004-2020 NCDB and ICD-O-3 code 9410.

Results: A total of 61 patients were identified in the NCDB database with the diagnosis of PA. The average age of diagnosis was 40.2 years (SD= 18.4, range- 3-88 years) with a male preponderance (64%). The majority of the patients (76%) were insured with either private insurance (56%) or Medicaid (20%). Approximately 86% of patients were non-Hispanic and 90% were white. The majority of patients (76%) lived in metropolitan areas. A higher percentage of patients reported residence in metropolitan counties with a population of 1 million or more (52%). Most patients (89%) had no comorbidities and a Charlson-Deyo score of 0. The top primary sites were the frontal lobe (48%), temporal lobe (25%), and the parietal lobe (10%). The average tumor size was 48.25 millimeters (SD= 14.86, Range=31-67 millimeters). Most individuals (87%) had surgical excision of the tumors. The most common specified surgical procedures were biopsy followed by gross excision of the lesion (12%), local tumor excision (10%), and photodynamic therapy (10%). 54% received radiation therapy and 33% received chemotherapy as their primary treatment. The survival rates were found to be 75% at two years and 64% at five years.

Conclusions: This is the first NCDB analysis on protoplasmic astrocytoma and therefore offers valuable insight into demographic and socioeconomic factors affecting diagnosis and treatment. The majority of patients diagnosed with PA did not have comorbidities and were found to be non-Hispanic, white, and male. The primary sites for PA were the frontal, temporal and parietal lobes, consistent with previous literature. Socioeconomic characteristics of patients showed that individuals with PA were more likely to have private insurance and live in metropolitan counties. In terms of treatment, patients receive surgical excision with adjunct combination therapies. Additional research is needed to determine the effect of demographic socioeconomic factors on diagnosis, staging, ability to promptly receive treatment, and survival.