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Spine (Phila Pa 1976). 2018 May 15;43(10):E565-E573. doi: 10.1097/BRS.0000000000002485.

Prognostic Factors and Treatment of Spinal Astrocytomas: A Multi-institutional Cohort Analysis.

Author information

1
Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
2
College of Acupuncture and Moxibustion, Tui-na, Hunan University of Chinese Medicine, Changsha, Hunan, China.
3
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA.
4
Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
5
Department of Neurosurgery, Duke University Hospital, Durham, NC.
6
Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy.
7
Department of Medicine, Crozer Chester Medical Center, Upland, PA.
8
Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
9
Cancer Research Institute of Xiangya School of Medicine, Central South University, Changsha, Hunan, China.
10
Deparment of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
11
Deparment of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
12
Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.

Abstract

STUDY DESIGN:

Retrospective cohort analysis of patients with spinal astrocytoma from multi-institutional data and the literature.

OBJECTIVE:

To determine the prognostic factors, treatment, and survival of patients.

SUMMARY OF BACKGROUND DATA:

Our current understanding of the epidemiology, prognosis, and optimal treatment of spinal astrocytoma is limited. The literature is confined to case reports or small institutional case series.

METHOD:

Patient demographics, tumor characteristics, treatments, and outcomes were extracted. Univariate Kaplan-Meier survival analysis was performed to identify prognostic factors followed by multivariate Cox proportional hazard analysis. Wilcoxon signed-rank test was performed on pre- and postoperational functional status as measured by McCormick score.

RESULTS:

Ninety-four patients from four institutions and 339 patients from the literature were included. For the multi-institutional cohort, WHO grade IV tumors had shorter progression-free survival (PFS) than those of lower grades, whereas gross total resection (GTR) (hazard ratio [HR]: 0.41, 95% confidence interval [CI]: 0.14-1.27, P = 0.124) trended toward longer PFS when compared to subtotal resection (STR). Age 18 years or older, paresthesia as a presenting symptom, and higher WHO grade were associated with shorter overall survival (OS), whereas thoracic tumor location when compared to cervical tumor location, biopsy when compared to STR, and radiotherapy (HR: 0.42, 95% CI: 0.20-0.88, P = 0.022) were associated with longer OS. For the literature cohort, GTR (HR 0.43, 95% CI: 0.24-0.77, P = 0.005) was associated with longer PFS when compared to STR, whereas higher WHO grade was associated with shorter PFS. Higher WHO grade and recurrence/progression were associated with shorter OS. Postoperative McCormick score was significantly higher than preoperative score (P < 0.001), but subgroup analysis of the change in McCormick score by extent of resection revealed no differences among groups (P = 0.551).

CONCLUSION:

In patients with spinal astrocytomas, GTR likely resulted in longer PFS when compared to STR. Adjuvant radiotherapy appears to be effective in improving survival outcomes for high-grade tumors.

LEVEL OF EVIDENCE:

4.

PMID:
29135884
DOI:
10.1097/BRS.0000000000002485
[Indexed for MEDLINE]

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