Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
Eur Spine J. 2021 Oct;30(10):2857-2866. doi: 10.1007/s00586-021-06724-4. Epub 2021 Jan 25.
Due to the rarity of diffuse spinal cord astrocytoma, an effective model is still lacking to stratify their prognosis. Here, we aimed to establish a prognostic model through comprehensively evaluating clinicopathological features and preoperative peripheral blood inflammatory markers in 89 cases.
We performed univariate and multivariate Cox regression to identify prognosis factors. The Kaplan-Meier curves and ROC curves were employed to compare the prognostic value of selected factors.
In addition to clinicopathological factors, we revealed the preoperative peripheral blood leukocyte count, neutrophils-to-lymphocytes ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were also significantly correlated with overall survival of spinal cord astrocytoma in univariate Cox regression, and NLR was still significant in multivariate Cox analysis. Further, we demonstrated that NLR ≤ 3.65 and preoperative McCormick score (MMS) ≤ 3 were independently correlated with better survival of WHO grade IV tumors. Meanwhile, Ki-67 < 10% and resection extent ≥ 90% were independent prognostic factors in WHO grade II/III tumors. Finally, we developed a prognostic model that had better predictive efficiencies than WHO grade and histological grade for 1-year (AUC = 76.6), 2- year (AUC = 80.9), and 3-year (AUC = 80.3) survival. This model could classify tumors into 4 classifications with increasingly poor prognosis: 1, WHO grade II/III, with Ki-67 < 10% and resection extent ≥ 90%; 2, WHO grade II/III, Ki-67 ≥ 10% or resection < 90%; 3, WHO grade IV, NLR ≤ 3.65 and MMS ≤ 3; 4, WHO grade IV, with NRL > 3.65 or MMS = 4.
We successfully constructed a comprehensive prognostic model including preoperative peripheral blood inflammatory markers, which can stratify diffuse spinal cord astrocytoma into 4 subgroups.
由于弥漫性脊髓星形细胞瘤较为罕见，因此仍然缺乏有效的分层预后模型。本研究旨在通过综合评估 89 例患者的临床病理特征和术前外周血炎症标志物，建立一种预后模型。
我们进行单因素和多因素 Cox 回归分析，以确定预后因素。采用 Kaplan-Meier 曲线和 ROC 曲线比较选定因素的预后价值。
除临床病理因素外，我们还发现术前外周血白细胞计数、中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）与脊髓星形细胞瘤的总生存时间在单因素 Cox 回归分析中也显著相关，且 NLR 在多因素 Cox 分析中仍有意义。进一步研究表明，NLR≤3.65 和术前 McCormick 评分（MMS）≤3 与 WHO 分级 IV 肿瘤的生存时间延长独立相关。同时，Ki-67<10%和切除程度≥90%是 WHO 分级 II/III 肿瘤的独立预后因素。最后，我们建立了一种预后模型，该模型在预测 1 年（AUC=76.6）、2 年（AUC=80.9）和 3 年（AUC=80.3）生存率方面的预测效能均优于 WHO 分级和组织学分级。该模型可将肿瘤分为 4 个分类，预后逐渐恶化：1、WHO 分级 II/III，Ki-67<10%和切除程度≥90%；2、WHO 分级 II/III，Ki-67≥10%或切除程度<90%；3、WHO 分级 IV，NLR≤3.65 和 MMS≤3；4、WHO 分级 IV，NLR>3.65 或 MMS=4。
我们成功构建了一个包含术前外周血炎症标志物的综合预后模型，可将弥漫性脊髓星形细胞瘤分为 4 个亚组。
