Shorter survival time of adolescents and young adult patients than older adults with spinal cord glioblastoma: a multicenter study

Tomoo Inoue Department of Neurosurgery, Saitama Red Cross Hospital, Saitama, Saitama, Japan;

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Toshiki Endo Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan;

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Jun Muto Department of Neurosurgery, Fujita Health University, Nagoya, Aichi, Japan;

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Daisuke Umebayashi Department of Neurosurgery, Kyoto Prefectural Hospital of Medicine, Kyoto, Kyoto, Japan;

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Takafumi Mitsuhara Department of Neurosurgery, Hiroshima University Graduate School of Medicine, Hiroshima, Hiroshima, Japan;

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Seiji Shigekawa Department of Neurosurgery, Ehime University, Ehime, Ehime, Japan;

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Ryo Kanematsu Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan;

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Motoyuki Iwasaki Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan;

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Toshihiro Takami Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Osaka, Osaka, Japan;

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Kazutoshi Hida Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Hokkaido, Japan; and

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Masaki Mizuno Department of Minimum Invasive Neurospinal Surgery, Mie University, Mie, Mie, Japan

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Investigators of Intramedullary Spinal Cord Tumors in the Neurospinal Society of Japan
Publication Date:
17 Nov 2023
Page Range:
1–10
Volume/Issue:
Publish Before Print
DOI link:
https://doi.org/10.3171/2023.9.SPINE23642
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OBJECTIVE

Cancers in adolescents and young adults (AYAs) (age 15–39 years) often present with unique characteristics and poor outcomes. To date, spinal cord glioblastoma, a rare tumor, remains poorly understood across all age groups, including AYAs. This comparative study aimed to investigate the clinical characteristics and outcomes of spinal cord glioblastoma in AYAs and older adults (age 40–74 years), given the limited availability of studies focusing on AYAs.

METHODS

Data from the Neurospinal Society of Japan’s retrospective intramedullary tumor registry (2009–2020) were analyzed. Patients were dichotomized on the basis of age into AYAs and older adults. Univariate and multivariate Cox proportional hazards regression models were utilized to explore risk factors for overall survival (OS).

RESULTS

A total of 32 patients were included in the study, with a median (range) age of 43 (15–74) years. Of these, 14 (43.8%) were AYAs and 18 (56.2%) were older adults. The median OS was 11.0 months in AYAs and 32.0 months in older adults, and the 1-year OS rates were 42.9% and 66.7%, respectively, with AYAs having a significantly worse prognosis (p = 0.017). AYAs had worse preoperative Karnofsky Performance Status (KPS) than older patients (p = 0.037). Furthermore, AYAs had larger intramedullary tumors on admission (p = 0.027) and a significantly higher frequency of intracranial dissemination during the clinical course (p = 0.048). However, there were no significant differences in the degrees of surgical removal or postoperative radiochemotherapy between groups. The Cox proportional hazards regression model showed that AYAs (HR 3.53, 95% CI 1.17–10.64), intracranial dissemination (HR 4.30, 95% CI 1.29–14.36), and no radiation therapy (HR 57.34, 95% CI 6.73–488.39) were risk factors for mortality for patients of all ages. Worse preoperative KPS did not predict mortality in AYAs but did in older adults. The high incidence of intracranial dissemination may play an important role in the poor prognosis of AYAs, but further studies are needed.

CONCLUSIONS

The clinical characteristics of AYAs with spinal cord glioblastoma differ from those of older adults. The prognosis of AYAs was clearly worse than that of older adults. The devastating clinical course of spinal glioblastoma in AYAs was in line with those of other cancers in this age group.

ABBREVIATIONS

AYA = adolescent and young adult; IQR = interquartile range; KPS = Karnofsky Performance Status; OS = overall survival.
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Contributor Notes

Correspondence Toshiki Endo: Tohoku Medical and Pharmaceutical University Fukumuro, Miyagi, Japan. endo@nsg.med.tohoku.ac.jp.

INCLUDE WHEN CITING Published online November 17, 2023; DOI: 10.3171/2023.9.SPINE23642.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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