Prognostic factors and nomogram prediction of survival probability in primary spinal cord astrocytoma patients

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  • 1 Department of Neurosurgery, Division of Spine, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University;
  • | 2 Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University; and
  • | 3 Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
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OBJECTIVE

Knowledge on the management of spinal cord astrocytoma (SCA) remains scarce. Here, the authors constructed and validated a predictive nomogram, often used for individualized prognosis and evaluations, to estimate cancer-specific survival (CSS) and overall survival (OS) for patients with SCA.

METHODS

Epidemiological characteristics were compared between low-grade SCA (LGSCA) and high-grade SCA (HGSCA) patients from the Surveillance, Epidemiology, and End Results (SEER) database. Risk factors for CSS and OS were determined using univariate and multivariate analyses and Kaplan-Meier curves. A nomogram was developed to individually predict the 3-, 5-, and 10-year CSS and OS rates. The clinical usefulness of the nomogram was assessed using calibration plots, the concordance index (C-index), and time-dependent receiver operating characteristic curves.

RESULTS

A total of 468 LGSCA and 165 HGSCA patients were eligible for inclusion. LGSCA and HGSCA patients demonstrated differences in age, tumor extension, insurance status, adjuvant treatment, and survival. Multivariate analysis demonstrated that in the LGSCA group, tumor extension, surgery type, and adjuvant therapy were individually associated with CSS. The distance of tumor extension and WHO grade were individually associated with CSS in the HGSCA group. The prognostic variables were further demonstrated using the Kaplan-Meier method, which also suggested that adjuvant treatment provided no advantage to HGSCA patients. A nomogram was constructed, and the C-index for CSS was 0.84 by internal validation (95% CI 0.79–0.90).

CONCLUSIONS

This research suggests that the distance of tumor extension, type of surgery, and adjuvant therapy are significant risk factors for CSS using multivariate analysis in the LGSCA group. Adjuvant treatment provided no advantages for CSS or OS in patients with HGSCAs. The nomogram may be clinically useful to healthcare providers.

ABBREVIATIONS

C-index = concordance index; CSS = cancer-specific survival; EOR = extent of resection; GTR = gross-total resection; HGSCA = high-grade SCA; LGSCA = low-grade SCA; OS = overall survival; ROC = receiver operating characteristic; SCA = spinal cord astrocytoma; SEER = Surveillance, Epidemiology, and End Results; STR = subtotal resection.

Supplementary Materials

    • Figs. S1-S3 and Tables S1-S4 (PDF 2,310 KB)

Images from Shimizu et al. (pp 616–623).

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  • 1

    Hsu S, Quattrone M, Ostrom Q, et al. Incidence patterns for primary malignant spinal cord gliomas: a Surveillance, Epidemiology, and End Results study. J Neurosurg Spine. 2011;14(6):742747.

    • Search Google Scholar
    • Export Citation
  • 2

    Ostrom QT, Gittleman H, Truitt G, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2011–2015. Neuro Oncol. 2018;20(suppl 4):iv1iv86.

    • Search Google Scholar
    • Export Citation
  • 3

    Abd-El-Barr MM, Huang KT, Moses ZB, et al. Recent advances in intradural spinal tumors. Neuro Oncol. 2018;20(6):729742.

  • 4

    McGirt MJ, Goldstein IM, Chaichana KL, et al. Extent of surgical resection of malignant astrocytomas of the spinal cord: outcome analysis of 35 patients. Neurosurgery. 2008;63(1):5561.

    • Search Google Scholar
    • Export Citation
  • 5

    Stupp R, Brada M, van den Bent MJ, et al. High-grade glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25(suppl 3):iii93iii101.

    • Search Google Scholar
    • Export Citation
  • 6

    Raco A, Piccirilli M, Landi A, et al. High-grade intramedullary astrocytomas: 30 years’ experience at the Neurosurgery Department of the University of Rome “Sapienza”. J Neurosurg Spine. 2010;12(2):144153.

    • Search Google Scholar
    • Export Citation
  • 7

    Minehan KJ, Brown PD, Scheithauer BW, et al. Prognosis and treatment of spinal cord astrocytoma. Int J Radiat Oncol Biol Phys. 2009;73(3):727733.

    • Search Google Scholar
    • Export Citation
  • 8

    Constantini S, Miller DC, Allen JC, et al. Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg. 2000;93(2)(suppl):183193.

    • Search Google Scholar
    • Export Citation
  • 9

    Minehan KJ, Shaw EG, Scheithauer BW, et al. Spinal cord astrocytoma: pathological and treatment considerations. J Neurosurg. 1995;83(4):590595.

    • Search Google Scholar
    • Export Citation
  • 10

    Babu R, Karikari IO, Owens TR, Bagley CA. Spinal cord astrocytomas: a modern 20-year experience at a single institution. Spine (Phila Pa 1976). 2014;39(7):533540.

    • Search Google Scholar
    • Export Citation
  • 11

    Adams H, Avendaño J, Raza SM, et al. Prognostic factors and survival in primary malignant astrocytomas of the spinal cord: a population-based analysis from 1973 to 2007. Spine (Phila Pa 1976). 2012;37(12):E727E735.

    • Search Google Scholar
    • Export Citation
  • 12

    Epstein FJ, Farmer JP, Freed D. Adult intramedullary astrocytomas of the spinal cord. J Neurosurg. 1992;77(3):355359.

  • 13

    Przybylski GJ, Albright AL, Martinez AJ. Spinal cord astrocytomas: long-term results comparing treatments in children. Childs Nerv Syst. 1997;13(7):375382.

    • Search Google Scholar
    • Export Citation
  • 14

    Kim MS, Chung CK, Choe G, et al. Intramedullary spinal cord astrocytoma in adults: postoperative outcome. J Neurooncol. 2001;52(1):8594.

  • 15

    Sandler HM, Papadopoulos SM, Thornton AF Jr, Ross DA. Spinal cord astrocytomas: results of therapy. Neurosurgery. 1992;30(4):490493.

  • 16

    Huddart R, Traish D, Ashley S, et al. Management of spinal astrocytoma with conservative surgery and radiotherapy. Br J Neurosurg. 1993;7(5):473481.

    • Search Google Scholar
    • Export Citation
  • 17

    Abdel-Wahab M, Etuk B, Palermo J, et al. Spinal cord gliomas: a multi-institutional retrospective analysis. Int J Radiat Oncol Biol Phys. 2006;64(4):10601071.

    • Search Google Scholar
    • Export Citation
  • 18

    Townsend N, Handler M, Fleitz J, Foreman N. Intramedullary spinal cord astrocytomas in children. Pediatr Blood Cancer. 2004;43(6):629632.

    • Search Google Scholar
    • Export Citation
  • 19

    Rodrigues GB, Waldron JN, Wong CS, Laperriere NJ. A retrospective analysis of 52 cases of spinal cord glioma managed with radiation therapy. Int J Radiat Oncol Biol Phys. 2000;48(3):837842.

    • Search Google Scholar
    • Export Citation
  • 20

    Nakamura M, Chiba K, Ishii K, et al. Surgical outcomes of spinal cord astrocytomas. Spinal Cord. 2006;44(12):740745.

  • 21

    Benes V III, Barsa P, Benes V Jr, Suchomel P. Prognostic factors in intramedullary astrocytomas: a literature review. Eur Spine J. 2009;18(10):13971422.

    • Search Google Scholar
    • Export Citation
  • 22

    Robinson CG, Prayson RA, Hahn JF, et al. Long-term survival and functional status of patients with low-grade astrocytoma of spinal cord. Int J Radiat Oncol Biol Phys. 2005;63(1):91100.

    • Search Google Scholar
    • Export Citation
  • 23

    Fakhreddine MH, Mahajan A, Penas-Prado M, et al. Treatment, prognostic factors, and outcomes in spinal cord astrocytomas. Neuro Oncol. 2013;15(4):406412.

    • Search Google Scholar
    • Export Citation
  • 24

    Zou Y, Sun J, Zhou Y, et al. Prognostic factors and treatment of spinal astrocytomas: a multi-institutional cohort analysis. Spine (Phila Pa 1976). 2018;43(10):E565E573.

    • Search Google Scholar
    • Export Citation
  • 25

    Santi M, Mena H, Wong K, et al. Spinal cord malignant astrocytomas. Clinicopathologic features in 36 cases. Cancer. 2003;98(3):554561.

  • 26

    Merchant TE, Nguyen D, Thompson SJ, et al. High-grade pediatric spinal cord tumors. Pediatr Neurosurg. 1999;30(1):15.

  • 27

    Cohen AR, Wisoff JH, Allen JC, Epstein F. Malignant astrocytomas of the spinal cord. J Neurosurg. 1989;70(1):5054.

  • 28

    Allen JC, Aviner S, Yates AJ, et al. Treatment of high-grade spinal cord astrocytoma of childhood with “8-in-1” chemotherapy and radiotherapy: a pilot study of CCG-945. J Neurosurg. 1998;88(2):215220.

    • Search Google Scholar
    • Export Citation
  • 29

    Guss ZD, Moningi S, Jallo GI, et al. Management of pediatric spinal cord astrocytomas: outcomes with adjuvant radiation. Int J Radiat Oncol Biol Phys. 2013;85(5):13071311.

    • Search Google Scholar
    • Export Citation
  • 30

    Bouffet E, Pierre-Kahn A, Marchal JC, et al. Prognostic factors in pediatric spinal cord astrocytoma. Cancer. 1998;83(11):23912399.

  • 31

    Sciubba DM, Liang D, Kothbauer KF, et al. The evolution of intramedullary spinal cord tumor surgery. Neurosurgery. 2009;65(6)(suppl):8492.

  • 32

    Diaz-Aguilar D, ReFaey K, Clifton W, et al. Prognostic factors and survival in low grade gliomas of the spinal cord: a population-based analysis from 2006 to 2012. J Clin Neurosci. 2019;61:1421.

    • Search Google Scholar
    • Export Citation
  • 33

    Chang SM, Parney IF, Huang W, et al. Patterns of care for adults with newly diagnosed malignant glioma. JAMA. 2005;293(5):557564.

  • 34

    Stupp R, Pavlidis N, Jelic S. ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of malignant glioma. Ann Oncol. 2005;16(suppl 1):i64i65.

    • Search Google Scholar
    • Export Citation
  • 35

    Cristante L, Herrmann HD. Surgical management of intramedullary spinal cord tumors: functional outcome and sources of morbidity. Neurosurgery. 1994;35(1):6976.

    • Search Google Scholar
    • Export Citation
  • 36

    Cheng L, Wang L, Yao Q, et al. Clinicoradiological characteristics of primary spinal cord H3 K27M-mutant diffuse midline glioma. J Neurosurg Spine. In press.

    • Search Google Scholar
    • Export Citation
  • 37

    Kaley TJ, Mondesire-Crump I, Gavrilovic IT. Temozolomide or bevacizumab for spinal cord high-grade gliomas. J Neurooncol. 2012;109(2):385389.

    • Search Google Scholar
    • Export Citation

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