J Neurooncol. 2013 Dec;115(3):493-503. doi: 10.1007/s11060-013-1251-y. Epub 2013 Sep 29.
Primary intramedullary spinal cord tumors are a rare entity, comprising 4–10 %of all spinal cord tumors. The current report presents data on intramedullary spinal cord anaplastic astrocytomas and glioblastomas in adults using the national surveillance, epidemiology, and end results database (1973–2008), and evaluates the impact of demographic and treatment factors on survival. Eighty nine adults were evaluated (mean age of 43 years); 49 % of patients had anaplastic astrocytoma and 51 % of patients had glioblastoma.88 % of patients had surgical intervention and 85 % of patients had radiotherapy. In univariate analysis, male gender (HR = 0.50, CI: 0.29–0.86, P = 0.01), surgical treatment (HR = 0.37, CI: 0.15–0.93, P = 0.03), and tumor histology (HR = 1.83, CI: 1.06–3.18, P = 0.03) were significant predictors of survival. Results remained significant or marginally significant after multivariate adjustment analyses. Adjuvant radiotherapy and age at diagnosis did not have a significant influence on survival. Future prospective studies from collaborative institutions combining richer detail in perioperative treatment, radiotherapy dosing, chemotherapy treatment, neurologic examinations, functional outcomes, and quality of life measures would contribute to more concrete, evidence-based treatment protocols for adult patients with primary malignant spinal cord astrocytomas.
原发性脊髓内肿瘤较为罕见，占所有脊髓肿瘤的 4-10%。本报告使用国家监测、流行病学和最终结果数据库（1973-2008 年）的数据，介绍成人脊髓内胶质母细胞瘤和间变性星形细胞瘤，评估人口统计学和治疗因素对生存的影响。89 名成年人接受了评估（平均年龄 43 岁）；49%的患者为间变性星形细胞瘤，51%的患者为胶质母细胞瘤。88%的患者接受了手术干预，85%的患者接受了放疗。单因素分析显示，男性（HR=0.50，CI：0.29-0.86，P=0.01）、手术治疗（HR=0.37，CI：0.15-0.93，P=0.03）和肿瘤组织学（HR=1.83，CI：1.06-3.18，P=0.03）是生存的显著预测因素。多因素调整分析后，结果仍然显著或具有统计学意义。辅助放疗和诊断时的年龄对生存没有显著影响。未来来自合作机构的前瞻性研究，结合围手术期治疗、放疗剂量、化疗治疗、神经学检查、功能结果和生活质量评估等方面更详细的信息，将有助于为成人原发性恶性脊髓星形细胞瘤患者制定更具体、基于证据的治疗方案。
