A comprehensive epidemiological review of spinal astrocytomas in the United States

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  • 1 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University;
  • 2 Case Western Reserve University School of Medicine;
  • 3 Department of Neurosurgery, Cleveland Clinic;
  • 4 Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio;
  • 5 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan;
  • 6 Central Brain Tumor Registry of the United States, Hinsdale, Illinois;
  • 7 Department of Population and Quantitative Health Science, Cleveland Center for Health Outcomes Research, Case Western Reserve University School of Medicine, Cleveland, Ohio; and
  • 8 Department of Medicine, Section of Epidemiology and Population Sciences, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
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OBJECTIVE

Spinal cord astrocytoma (SCA) is a rare tumor whose epidemiology has not been well defined. The authors utilized the Central Brain Tumor Registry of the United States (CBTRUS) to provide comprehensive up-to-date epidemiological data for this disease.

METHODS

The CBTRUS was queried for SCAs on ICD-O-3 (International Classification of Diseases for Oncology, 3rd edition) histological and topographical codes. The age-adjusted incidence (AAI) per 100,000 persons was calculated and stratified by race, sex, age, and ethnicity. Joinpoint was used to calculate the annual percentage change (APC) in incidence.

RESULTS

Two thousand nine hundred sixty-nine SCAs were diagnosed in the US between 1995 and 2016, resulting in an average of approximately 136 SCAs annually. The overall AAI was 0.047 (95% CI 0.045–0.049), and there was a statistically significant increase from 0.051 in 1995 to 0.043 in 2016. The peak incidence of 0.064 (95% CI 0.060–0.067) was found in the 0- to 19-year age group. The incidence in males was 0.053 (95% CI 0.050–0.055), which was significantly greater than the incidence in females (0.041, 95% CI 0.039–0.044). SCA incidence was significantly lower both in patients of Asian/Pacific Islander race (AAI = 0.034, 95% CI 0.028–0.042, p = 0.00015) and in patients of Hispanic ethnicity (AAI = 0.035, 95% CI 0.031–0.039, p < 0.001). The incidence of WHO grade I SCAs was significantly higher than those of WHO grade II, III, or IV SCAs (p < 0.001).

CONCLUSIONS

The overall AAI of SCA from 1995 to 2016 was 0.047 per 100,000. The incidence peaked early in life for both sexes, reached a nadir between 20 and 34 years of age for males and between 35 and 44 years of age for females, and then slowly increased throughout adulthood, with a greater incidence in males. Pilocytic astrocytomas were the most common SCA in the study cohort. This study presents the most comprehensive epidemiological study of SCA incidence in the US to date.

ABBREVIATIONS AAI = age-adjusted incidence; APC = annual percentage change; CBTRUS = Central Brain Tumor Registry of the United States; CI = confidence interval; ICD-O-3 = International Classification of Diseases for Oncology, 3rd edition; IRR = incidence rate ratio; NOS = not otherwise specified; SCA = spinal cord astrocytoma; SEER = Surveillance, Epidemiology, and End Results.

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Contributor Notes

Correspondence Pablo F. Recinos: Cleveland Clinic, Cleveland, OH. recinop@ccf.org.

INCLUDE WHEN CITING Published online November 6, 2020; DOI: 10.3171/2020.6.SPINE191532.

Disclosures Dr. Kshettry reports being a consultant to Integra.

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