DIPG-20. SURGICAL INTERVENTION’S CORRELATION WITH SUBSEQUENT METASTASIS DEVELOPMENT IN CHILDREN WITH DIFFUSE INTRINSIC PONTINE GLIOMAS (DIPG)

Abstract BACKGROUND Diffuse intrinsic pontine glioma (DIPG) is a highly aggressive pediatric brain tumor with a poor prognosis. Currently, there is no curative treatment option available for these patients. These patients often undergo surgery to confirm the diagnosis pathologically. However, the relationship between surgery and dissemination is to be confirmed. This retrospective cohort determines if surgical intervention increases the risk of dissemination and what other factors may also be associated. METHODS The final analysis included 142 pediatric (age ≤ 12) DIPG patients treated at Sanjiu Brain Hospital between January 2017 and June 2023. The data were retrospectively collected following the initial diagnosis. The diagnosis was established based on imaging studies. Three radiologists analyzed the imaging data. The endpoint was the occurrence of subsequent metastasis. Univariable and multivariable logistic regressions were performed to identify predictors of subsequent dissemination. All statistical assessments were two-tailed; only P < 0.05 was considered statistically significant. RESULTS Of 142 patients, 28 (19.7%) developed metastasis, and 114 (80.3%) had no evidence of metastasis. There were 77 (54.2%) males and 65 (45.8%) females. The patients’ median age was 7 years (1-12 yrs.). Patients were followed up for at least 6 months or until they developed subsequent metastasis or died without developing metastasis. Univariate logistic regression analysis demonstrated that surgery (OR 4.277, 95%CI 1.753 - 11.607, P=0.002), adjuvant temozolomide (OR 2.891, 95%CI 1.097 - 9.106, P=0.045), and adjuvant bevacizumab (OR 10.278, 95%CI 3.759 - 9.444, P=0.003) were the potential predictor of metastasis development. Multivariate logistic regression analysis showed that surgery (OR 5.061, 95%CI 1.966 - 14.508, P=0.001) and administration of adjuvant bevacizumab (OR 3.020, 95%CI 1.196 - 8.065, P=0.022) were the independent predictors of dissemination. CONCLUSION Surgery and adjuvant bevacizumab may increase the risk of subsequent metastasis in the pediatric DIPG population.