{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T21:15:06Z","timestamp":1785014106287,"version":"3.55.0"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T00:00:00Z","timestamp":1635206400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Objective<\/jats:title><jats:p>This study aimed to evaluate the characteristics of children with primary brain tumors, the effectiveness of treatment modalities, and to detect factors related to the outcome.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>A detailed analysis was performed on a series of 173 pediatric patients treated in a Serbian referral oncology institution between 2007 and 2016, based on their clinical, histological, treatment, and follow-up data.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Mean survival time of all children was 94.5months. 2-, 5- and 10-year overall survival probabilities were 68.8%, 59.4%, and 52.8%, respectively. Patients with supratentorial tumors had longer survival than patients with infratentorial tumors and patients with tumors in both compartments (p = 0.011). Children with the unknown histopathology (brainstem glioma) and high-grade glioma had a shorter life than embryonal tumors, ependymoma, and low-grade glioma (p&lt;0.001). Survival of the children who underwent gross total resection was longer than the children in whom lesser degrees of resection were achieved (p = 0.015). The extent of the disease is a very important parameter found to be associated with survival. Patients with no evidence of disease after surgery had a mean survival of 123 months, compared with 82 months in patients with local residual disease and 55 months in patients with disseminated disease (p&lt;0.001). By the univariate analysis, factors predicting poor outcome in our series were the presentation of disease with hormonal abnormalities, tumor location, and the extent of the disease, while the factors predicting a better outcome were age at the time of diagnosis, presentation of the disease with neurological deficit, and type of resection. By the multivariate analysis, the extent of the disease remained as the only strong adverse risk factor for survival (HR 2.06; 95% CI = 1.38\u20133.07; p&lt;0.001).<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>With an organized and dedicated multidisciplinary team, the adequate outcomes can be achieved in a middle-income country setting. The presence of local residual disease after surgery and disseminated disease has a strong negative effect on survival.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0259095","type":"journal-article","created":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T17:29:07Z","timestamp":1635269347000},"page":"e0259095","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["Clinical profile, treatment and outcome of pediatric brain tumors in Serbia in a 10-year period: A national referral institution experience"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8335-5661","authenticated-orcid":true,"given":"Dragana","family":"Stani\u0107","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danica","family":"Gruji\u010di\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7978-1409","authenticated-orcid":true,"given":"Tatjana","family":"Pekmezovi\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelena","family":"Bokun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marija","family":"Popovi\u0107-Vukovi\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragana","family":"Jani\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lejla","family":"Paripovi\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vesna","family":"Ili\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marija","family":"Pudrlja Slovi\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosanda","family":"Ili\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savo","family":"Rai\u010devi\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milan","family":"Sari\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Mi\u0161kovi\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borko","family":"Nid\u017eovi\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7272-9587","authenticated-orcid":true,"given":"Marina","family":"Nikitovi\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,10,26]]},"reference":[{"key":"pone.0259095.ref001","volume-title":"SEER Cancer Statistics Review, 1975\u20132018","author":"N Howlader"},{"issue":"13","key":"pone.0259095.ref002","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1016\/j.ejca.2006.05.009","article-title":"Childhood central nervous system tumours\u2014incidence and survival in Europe (1978\u20131997): Report from Automated Childhood Cancer Information System project","volume":"42","author":"R Peris-Bonet","year":"2006","journal-title":"Eur J Cancer"},{"key":"pone.0259095.ref003","doi-asserted-by":"crossref","first-page":"V1","DOI":"10.1093\/neuonc\/noz150","article-title":"CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2012\u20132016","volume":"21","author":"QT Ostrom","year":"2019","journal-title":"Neuro Oncol."},{"key":"pone.0259095.ref004","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.jocn.2019.05.003","article-title":"Global incidence of brain and spinal tumors by geographic region and income level based on cancer registry data","volume":"66","author":"JS Bell","year":"2019","journal-title":"J Clin Neurosci"},{"key":"pone.0259095.ref005","doi-asserted-by":"crossref","first-page":"83","DOI":"10.3322\/caac.21219","article-title":"Childhood and adolescent cancer statistics, 2014","volume":"64","author":"E Ward","year":"2014","journal-title":"CA Cancer j Clin."},{"key":"pone.0259095.ref006","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.ejca.2017.05.028","article-title":"Geographical variability in survival of European children with central nervous system tumours","volume":"82","author":"G Gatta","year":"2017","journal-title":"Eur J Cancer"},{"issue":"2","key":"pone.0259095.ref007","doi-asserted-by":"crossref","first-page":"135","DOI":"10.3171\/2011.5.PEDS1178","article-title":"Multidisciplinary management of childhood brain tumors: a review of outcomes, recent advances, and challenges","volume":"8","author":"IF Pollack","year":"2011","journal-title":"J Neurosurg Pediatrics"},{"issue":"4","key":"pone.0259095.ref008","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.cppeds.2011.12.002","article-title":"Brain tumors in children","volume":"42","author":"AJ Fleming","year":"2012","journal-title":"Curr.Probl.Pediatr.Adolesc Health Care"},{"issue":"4","key":"pone.0259095.ref009","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1177\/0883073815597756","article-title":"Improving Care in Pediatric Neuro-oncology Patients: An Overview of the Unique Needs of Children with Brain Tumors","volume":"31","author":"C Fischer","year":"2016","journal-title":"J Child Neurol"},{"issue":"11","key":"pone.0259095.ref010","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1093\/neuonc\/noz123","article-title":"Risk factors for childhood and adult primary brain tumors","volume":"21","author":"QT Ostrom","year":"2019","journal-title":"Neuro Oncol"},{"issue":"6","key":"pone.0259095.ref011","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1007\/s00401-016-1545-1","article-title":"The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary","volume":"131","author":"DN Louis","year":"2016","journal-title":"Acta Neuropathol"},{"issue":"3","key":"pone.0259095.ref012","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1002\/path.5457","article-title":"Advances in the molecular classification of pediatric brain tumors: a guide to the galaxy","volume":"251","author":"C Cacciotti","year":"2020","journal-title":"J Pathol"},{"issue":"7","key":"pone.0259095.ref013","first-page":"1962","article-title":"Integrated Proteogenomic Characterization across Major Histological Types of Pediatric Brain Cancer","volume":"183","author":"A Francis","year":"2021","journal-title":"HHS Public Access"},{"issue":"2","key":"pone.0259095.ref014","doi-asserted-by":"crossref","first-page":"15","DOI":"10.4252\/wjsc.v10.i2.15","article-title":"Spatiotemporal switching signals for cancer stem cell activation in pediatric origins of adulthood cancer: Towards a watch-and-wait lifetime strategy for cancer treatment","volume":"10","author":"SC Li","year":"2018","journal-title":"World J Stem Cells"},{"issue":"1","key":"pone.0259095.ref015","first-page":"1","article-title":"Cancer genomic research at the crossroads: Realizing the changing genetic landscape as intratumoral spatial and temporal heterogeneity becomes a confounding factor","volume":"14","author":"SC Li","year":"2014","journal-title":"Cancer Cell Int"},{"issue":"2","key":"pone.0259095.ref016","first-page":"290","article-title":"Outcome of childhood brain tumors in Serbia","volume":"16","author":"M Nikitovic","year":"2011","journal-title":"J BUON"},{"issue":"1","key":"pone.0259095.ref017","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s00381-015-2945-6","article-title":"Pediatric glioblastoma: a single institution experience","volume":"32","author":"M Nikitovic","year":"2016","journal-title":"Childs Nerv Syst"},{"issue":"4","key":"pone.0259095.ref018","first-page":"1156","article-title":"Management and Treatment of Children with Medulloblastoma in Serbia, a Middle-Income Country","volume":"23","author":"J Bokun","year":"2018","journal-title":"J BUON."},{"issue":"1","key":"pone.0259095.ref019","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1055\/s-0030-1268495","article-title":"Epidemiology of pediatric brain tumors in Greece (1991\u20132008). Experience from the \u201cAgia Sofia\u201d Children\u2019s Hospital","volume":"72","author":"GA Alexiou","year":"2011","journal-title":"Central Eur Neurochir."},{"key":"pone.0259095.ref020","first-page":"1","article-title":"Survival from tumours of the central nervous system in Danish children: Is survival related to family circumstances?","volume":"00","author":"F Erdmann","year":"2017","journal-title":"International Journal of Cancer"},{"key":"pone.0259095.ref021","first-page":"323","article-title":"Survival and Prognostic Factors in Children with Brain Tumors: Long-term Follow-up Single Center Study in Poland","volume":"326","author":"M Pogorzala","year":"2014","journal-title":"Anticancer research"},{"issue":"7","key":"pone.0259095.ref022","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1007\/s00381-016-3088-0","article-title":"Pediatric central nervous system tumors: review of a single Portuguese institution","volume":"32","author":"MM Santos","year":"2016","journal-title":"Child\u2019s Nerv Syst"},{"key":"pone.0259095.ref023","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.neuchi.2012.01.005","article-title":"Epidemiology of pediatric primary tumors of the nervous system: A retrospective study of 633 cases from a single Moroccan institution","volume":"58","author":"A Harmouch","year":"2012","journal-title":"Neurochirurgie"},{"issue":"5","key":"pone.0259095.ref024","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1159\/000149905","article-title":"Descriptive epidemiology of childhood central nervous system tumours in Tunisia: Experience of a single institution over a 15-year period (1990\u20132004)","volume":"44","author":"S Bellil","year":"2008","journal-title":"Pediatr Neurosurg"},{"issue":"8","key":"pone.0259095.ref025","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1007\/s00381-011-1407-z","article-title":"Pediatric tumors of the central nervous system: a retrospective study of 1,043 cases from a tertiary care center in South India","volume":"27","author":"JR Asirvatham","year":"2011","journal-title":"Childs Nerv Syst"},{"key":"pone.0259095.ref026","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.jocn.2005.08.013","article-title":"Paediatric central nervous system tumours in a New Zealand population: A 10-year experience of epidemiology, management strategies and outcomes","volume":"13","author":"S Monteith","year":"2006","journal-title":"Journal of Clinical Neuroscience"},{"issue":"8","key":"pone.0259095.ref027","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1097\/MPH.0b013e31822031d9","article-title":"Pediatric Central Nervous System Tumors: A Single-center Experience From 1989 to 2009","volume":"33","author":"RS Pinho","year":"2011","journal-title":"J Pediatr Hematol Oncol"},{"issue":"3","key":"pone.0259095.ref028","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s00381-018-04032-9","article-title":"Patterns, treatments, and outcomes of pediatric central nervous system tumors in Sudan: a single institution experience","volume":"35","author":"MMA Elhassan","year":"2019","journal-title":"Child\u2019s Nerv Syst"},{"issue":"1","key":"pone.0259095.ref029","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s00381-013-2297-z","article-title":"Presentation, pathology, and treatment outcome of brain tumors in 172 consecutive children at CURE Children\u2019s Hospital of Uganda. The predominance of the visible diagnosis and the uncertainties of epidemiology in sub-Saharan Africa","volume":"30","author":"V Stagno","year":"2014","journal-title":"Child\u2019s Nerv Syst."},{"issue":"6","key":"pone.0259095.ref030","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1159\/000337872","article-title":"Descriptive epidemiology of pediatric intracranial neoplasms in Egypt","volume":"47","author":"MA El-Gaidi","year":"2012","journal-title":"Pediatr Neurosurg"},{"issue":"7","key":"pone.0259095.ref031","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s00381-013-2105-9","article-title":"Pediatric brain tumors in Nigeria: Clinical profile, management strategies, and outcome","volume":"29","author":"EO Uche","year":"2013","journal-title":"Child\u2019s Nerv Syst."},{"issue":"6","key":"pone.0259095.ref032","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1111\/ped.12369","article-title":"Duration between onset and diagnosis in central nervous system tumors: Impact on prognosis and functional outcome","volume":"56","author":"K Fukuoka","year":"2014","journal-title":"Pediatr Int"},{"issue":"1","key":"pone.0259095.ref033","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s11060-008-9740-0","article-title":"Clinical epidemiology for childhood primary central nervous system tumors","volume":"92","author":"L Bauchet","year":"2009","journal-title":"J Neurooncol"},{"issue":"4","key":"pone.0259095.ref034","doi-asserted-by":"crossref","first-page":"562","DOI":"10.4103\/ijc.IJC_66_17","article-title":"Pediatric brain tumors: An analysis of 5 years of data from a tertiary cancer center, India","volume":"53","author":"R Madhavan","year":"2016","journal-title":"Indian J Cancer"},{"issue":"6","key":"pone.0259095.ref035","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1016\/j.wneu.2015.07.074","article-title":"Pediatric central nervous system tumors in Nepal: Retrospective analysis and literature review of low- and middle-income countries","volume":"84","author":"TD Azad","year":"2015","journal-title":"World Neurosurg"},{"issue":"3","key":"pone.0259095.ref036","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.wneu.2014.06.040","article-title":"Central nervous system tumor distribution at a tertiary referral center in Uganda","volume":"82","author":"J Hatef","year":"2014","journal-title":"World Neurosurg"},{"key":"pone.0259095.ref037","doi-asserted-by":"crossref","first-page":"1429615","DOI":"10.1155\/2020\/1429615","article-title":"The Epidemiology of Primary Central Nervous System Tumors at the National Neurologic Institute in Saudi Arabia: A Ten-Year Single-Institution Study","volume":"2020","author":"A Almutrafi","year":"2020","journal-title":"J Cancer Epidemiol"},{"issue":"12","key":"pone.0259095.ref038","doi-asserted-by":"crossref","first-page":"3155","DOI":"10.1002\/1097-0142(20011215)92:12<3155::AID-CNCR10158>3.0.CO;2-C","article-title":"pulation-based epidemiologic data on brain tumors in German children","volume":"92","author":"P Kaatsch","year":"2001","journal-title":"Cancer"},{"issue":"10","key":"pone.0259095.ref039","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1016\/j.jocn.2012.01.028","article-title":"Paediatric brain tumours treated at a single, tertiary paediatric neurosurgical referral centre from 1999 to 2010 in Australia","volume":"19","author":"M Ramanan","year":"2012","journal-title":"J Clin Neurosci."},{"issue":"2","key":"pone.0259095.ref040","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s11060-015-1979-7","article-title":"Pediatric brain tumors in a low\/middle income country: Does it differ from that in developed world?","volume":"126","author":"S Ezzat","year":"2016","journal-title":"J Neurooncol"},{"issue":"10","key":"pone.0259095.ref041","doi-asserted-by":"crossref","first-page":"1620","DOI":"10.1111\/j.1651-2227.2009.01417.x","article-title":"Classification, incidence and survival analyses of children with CNS tumours diagnosed in Sweden 1984\u20132005","volume":"98","author":"B Lannering","year":"2009","journal-title":"Acta Paediatr Int J Paediatr"},{"issue":"3","key":"pone.0259095.ref042","doi-asserted-by":"crossref","first-page":"261","DOI":"10.3171\/2018.10.PEDS18377","article-title":"Childhood brain tumors: current management, biological insights, and future directions","volume":"23","author":"IF Pollack","year":"2019","journal-title":"J Neurosurg Pediatr"},{"issue":"10","key":"pone.0259095.ref043","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1007\/s12094-013-1041-1","article-title":"Ependymoma in children: molecular considerations and therapeutic insights","volume":"15","author":"JH Kim","year":"2013","journal-title":"Clin Transl Oncol"},{"issue":"24","key":"pone.0259095.ref044","doi-asserted-by":"crossref","first-page":"5761","DOI":"10.1002\/cncr.24663","article-title":"Outcome and prognostic features in pediatric gliomas: a review of 6212 cases from the surveillance, epidemiology and end results (SEER) database","volume":"115","author":"I Qaddoumi","year":"2009","journal-title":"Cancer"},{"issue":"2 Neuro-oncology","key":"pone.0259095.ref045","first-page":"373","article-title":"Pediatric brain tumors","volume":"21","author":"EM Wells","year":"2015","journal-title":"Continuum (MinneapMinn)"},{"key":"pone.0259095.ref046","author":"World Bank","year":"2020","journal-title":"Country and Lending Groups"},{"issue":"17","key":"pone.0259095.ref047","doi-asserted-by":"crossref","first-page":"2665","DOI":"10.1016\/j.ejca.2015.08.018","article-title":"Childhood central nervous system tumor mortality and survival in Southern and Eastern Europe (1983\u20132014): Gaps persist across 14 cancer registries","volume":"51","author":"MA Karalexi","year":"2015","journal-title":"Eur J Cancer"},{"issue":"1","key":"pone.0259095.ref048","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s11060-020-03582-w","article-title":"Pediatric primary central nervous system tumors registry in Thailand under National Health Security Office schemes","volume":"149","author":"B Pongtanakul","year":"2020","journal-title":"J Neurooncol"},{"issue":"8","key":"pone.0259095.ref049","doi-asserted-by":"crossref","first-page":"706","DOI":"10.4252\/wjsc.v12.i8.706","article-title":"Hunting down the dominating subclone of cancer stem cells as a potential new therapeutic target in multiple myeloma: An artificial intelligence perspective","volume":"12","author":"LX Lee","year":"2020","journal-title":"World J Stem Cells"},{"issue":"545","key":"pone.0259095.ref050","doi-asserted-by":"crossref","first-page":"eaaz5387","DOI":"10.1126\/scitranslmed.aaz5387","article-title":"Blocking immunosuppressive neutrophils deters pY696-EZH2\u2013driven brain metastases","volume":"12","author":"L Zhang","year":"2020","journal-title":"Sci Transl Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259095","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T21:45:19Z","timestamp":1673646319000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259095"}},"subtitle":[],"editor":[{"given":"Shengwen Calvin","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,10,26]]},"references-count":50,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0259095","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,26]]}}}