Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
College of Acupuncture and Moxibustion, Tui-na, Hunan University of Chinese Medicine, Changsha, Hunan, China.
Spine (Phila Pa 1976). 2018 May 15;43(10):E565-E573. doi: 10.1097/BRS.0000000000002485.
Retrospective cohort analysis of patients with spinal astrocytoma from multi-institutional data and the literature.
To determine the prognostic factors, treatment, and survival of patients.
Our current understanding of the epidemiology, prognosis, and optimal treatment of spinal astrocytoma is limited. The literature is confined to case reports or small institutional case series.
Patient demographics, tumor characteristics, treatments, and outcomes were extracted. Univariate Kaplan-Meier survival analysis was performed to identify prognostic factors followed by multivariate Cox proportional hazard analysis. Wilcoxon signed-rank test was performed on pre- and postoperational functional status as measured by McCormick score.
Ninety-four patients from four institutions and 339 patients from the literature were included. For the multi-institutional cohort, WHO grade IV tumors had shorter progression-free survival (PFS) than those of lower grades, whereas gross total resection (GTR) (hazard ratio [HR]: 0.41, 95% confidence interval [CI]: 0.14-1.27, P = 0.124) trended toward longer PFS when compared to subtotal resection (STR). Age 18 years or older, paresthesia as a presenting symptom, and higher WHO grade were associated with shorter overall survival (OS), whereas thoracic tumor location when compared to cervical tumor location, biopsy when compared to STR, and radiotherapy (HR: 0.42, 95% CI: 0.20-0.88, P = 0.022) were associated with longer OS. For the literature cohort, GTR (HR 0.43, 95% CI: 0.24-0.77, P = 0.005) was associated with longer PFS when compared to STR, whereas higher WHO grade was associated with shorter PFS. Higher WHO grade and recurrence/progression were associated with shorter OS. Postoperative McCormick score was significantly higher than preoperative score (P < 0.001), but subgroup analysis of the change in McCormick score by extent of resection revealed no differences among groups (P = 0.551).
In patients with spinal astrocytomas, GTR likely resulted in longer PFS when compared to STR. Adjuvant radiotherapy appears to be effective in improving survival outcomes for high-grade tumors.
多机构数据和文献回顾性队列分析脊髓星形细胞瘤患者。
确定患者的预后因素、治疗方法和生存情况。
目前我们对脊髓星形细胞瘤的流行病学、预后和最佳治疗方法的了解有限。文献仅限于病例报告或小型机构病例系列。
提取患者的人口统计学、肿瘤特征、治疗方法和结果。采用单因素 Kaplan-Meier 生存分析确定预后因素，然后进行多因素 Cox 比例风险分析。采用 McCormick 评分测量术前和术后功能状态的 Wilcoxon 符号秩检验。
来自四个机构的 94 名患者和文献中的 339 名患者被纳入研究。对于多机构队列，与低级别肿瘤相比，WHO 级别 IV 肿瘤的无进展生存期（PFS）更短，而与次全切除术（STR）相比，完全切除术（GTR）（风险比[HR]：0.41，95%置信区间[CI]：0.14-1.27，P=0.124）更倾向于延长 PFS。18 岁或以上、感觉异常为首发症状和较高的 WHO 分级与总生存期（OS）较短相关，而与颈椎肿瘤位置相比，胸椎肿瘤位置、活检与 STR 相比、放疗（HR：0.42，95%CI：0.20-0.88，P=0.022）与 OS 较长相关。对于文献队列，与 STR 相比，GTR（HR 0.43，95%CI：0.24-0.77，P=0.005）与较长的 PFS 相关，而较高的 WHO 分级与较短的 PFS 相关。较高的 WHO 分级和复发/进展与较短的 OS 相关。术后 McCormick 评分明显高于术前评分（P<0.001），但按切除范围对术后 McCormick 评分变化的亚组分析显示各组之间无差异（P=0.551）。
在脊髓星形细胞瘤患者中，与 STR 相比，GTR 可能导致更长的 PFS。辅助放疗似乎可有效改善高级别肿瘤的生存结果。
4 级。
