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KMID : 1189320160100040748
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Asian Spine Journal
2016 Volume.10 No. 4 p.748 ~ p.754
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Clinical Factors for Prognosis and Treatment Guidance of Spinal Cord Astrocytoma
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Seki Toshitaka
Hida Kazutoshi
Yano Shunsuke
Aoyama Takeshi
Koyanagi Izumi
Sasamori Toru
Hamauch Shuji
Houkin Kiyohiro
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Abstract
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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.
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KEYWORD
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Astrocytoma, Intramedullary tumor, Outcome, Radiotherapy, Surgery
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