Clinical Factors for Prognosis and Treatment Guidance of Spinal Cord Astrocytoma.
10.4184/asj.2016.10.4.748
- Author:
Toshitaka SEKI
1
;
Kazutoshi HIDA
;
Shunsuke YANO
;
Takeshi AOYAMA
;
Izumi KOYANAGI
;
Toru SASAMORI
;
Shuji HAMAUCH
;
Kiyohiro HOUKIN
Author Information
1. Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. toseki1@hotmail.com
- Publication Type:Original Article
- Keywords:
Astrocytoma;
Intramedullary tumor;
Outcome;
Radiotherapy;
Surgery
- MeSH:
Astrocytoma*;
Cordotomy;
Humans;
Incidence;
Multivariate Analysis;
Prognosis*;
Radiotherapy;
Radiotherapy, Adjuvant;
Retrospective Studies;
Spinal Cord*;
Survival Rate
- From:Asian Spine Journal
2016;10(4):748-754
- CountryRepublic of Korea
- Language:English
-
Abstract:
STUDY DESIGN: Retrospective study. PURPOSE: To obtain information useful in establishing treatment guidelines by evaluating baseline clinical features and treatment outcomes of patients with spinal cord astrocytoma (SCA). OVERVIEW OF LITERATURE: The optimal management of SCA remains controversial, and there are no standard guidelines. METHODS: The study included 20 patients with low-grade and 13 with high-grade SCA surgically treated between 1989 and 2014. Patients were classified according to the extent of surgical resection. Survival was assessed using Kaplan-Meier plots and compared between groups by log-rank tests. Neurological status was defined by the modified McCormick scale and compared between groups by Mann-Whitney U tests. RESULTS: Surgical resection was performed for 19 of 20 low-grade (95%) and 10 of 13 high-grade (76.9%) SCA patients. Only nine patients (27.3%) underwent gross total resection, all of whom had low-grade SCA. Of all patients, 51.5% showed deteriorated neurological status compared to preoperative baseline. Median overall survival was significantly longer for low-grade SCA than that (91 months, 78% at 5 years vs. 15 months, 31% at 5 years; p=0.007). Low-grade SCA patients benefited from more aggressive resection, whereas high-grade SCA patients did not. Multivariate analysis revealed histology status (hazard ratio [HR], 0.30; 95% confidence interval [CI], 0.09-0.98; p<0.05) and postoperative neurological status (HR, 0.12; CI, 0.02-0.95; p<0.05) as independent predictors of longer overall survival. Adjuvant radiotherapy had no significant impact on survival rate. However, a trend for increased survival was observed with radiation cordotomy (RCT) in high-grade SCA patients. CONCLUSIONS: Aggressive resection for low-grade and RCT may prolong survival. Preservation of neurological status is an important treatment goal. Given the low incidence of SCA, establishing strong collaborative, interdisciplinary, and multi-institutional study groups is necessary to define optimal treatments.
