Risk assessment in paediatric glioma-Time to move on from the binary classification

- Paediatric glioma encompasses a broad spectrum of disease with highly variable prognoses.
- Consistent risk factors affecting prognosis are well established for high-grade and low-grade glioma.
- Risk classification for paediatric glioma is possible and should be pursued.

BackgroundPaediatric glioma encompasses a wide range of entities with highly variable prognoses. Gliomas are grouped by histopathological features into high- and low-grade glioma but this classification until recently has not taken into account many emerging risk factors in this disease. A comprehensive risk classification has not been published for paediatric glioma despite many risk factors being established in this disease.MethodsA comprehensive literature review was carried out identifying risk factors for paediatric low-grade and high-grade glioma.ResultsThe most consistently described risk factors in high-grade glioma included midline location and extent of surgical resection. For patients with progressive unresectable low-grade glioma, age under 1, neurofibromatosis type I status and location were the most consistently prognostic. Molecular classification shows promise in accurately reassigning diagnosis for some gliomas.ConclusionRisk profiling in paediatric glioma will require a focused multinational effort but will result in a more accurate and nuanced assessment of prognosis.