Kageyama Hiroto, Tatebayashi Kotaro, Yoshimura Shinichi, Endo Toshiki, Hida Kazutoshi, Mizuno Masaki
Department of Neurosurgery, Hyogo Medical University, Hyogo, Japan.
Division of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Neurospine. 2023 Jun;20(2):678-691. doi: 10.14245/ns.2346390.195. Epub 2023 Jun 30.
Intramedullary spinal cord tumors (IMSCTs) are uncommon and difficult to treat. Studies examining the efficacy of rare IMSCT surgery in the elderly are limited. We conducted a subanalysis using multicenter retrospective-historical data provided by the Japan Neurospinal Society to compare surgical outcomes between older and younger adults with IMSCTs.
We classified patients with IMSCTs into younger (aged 18-64 years) or older ( ≥ 65 years) groups. The primary outcomes of "improved" or "worsened" from the preoperative period to 6 months after surgery were evaluated using the modified McCormick scale (mMCs). A favorable outcome was defined as an mMCs grade of I/II at 6 months.
Among 841 patients registered, there were 658 younger (78.2%) and 183 older patients (21.8%) evaluated using mMCs at 6 months. Median preoperative mMCs grades were significantly worse in older patients than in younger patients. Neither the "improved" nor "worsened" rate differed significantly between the groups (28.1% vs. 25.1%; crude odds ratio [cOR], 0.86; 95% confidence interval [CI], 0.59-1.25; adjusted OR [aOR], 0.84; 95% CI, 0.55-1.28; 16.9% vs. 23.0%; cOR, 1.47; 95% CI, 0.98-2.20; aOR, 1.28; 95% CI, 0.83-1.97). Favorable outcomes were significantly less common among older adults in the univariate analysis but were not significant in the multivariate analysis (66.4% vs. 53.0%; cOR, 0.57; 95% CI, 0.41-0.80; aOR, 0.77; 95% CI, 0.50-1.19). In both younger and older patients, preoperative mMCs accurately predicted favorable outcomes.
Age alone is not a sufficient reason to prohibit surgery for IMSCTs.
脊髓髓内肿瘤（IMSCTs）较为罕见且治疗困难。关于老年患者罕见IMSCT手术疗效的研究有限。我们利用日本神经脊柱学会提供的多中心回顾性历史数据进行了一项亚分析，以比较老年和年轻IMSCT患者的手术结果。
我们将IMSCT患者分为年轻组（18 - 64岁）或老年组（≥65岁）。使用改良麦考密克量表（mMCs）评估从术前到术后6个月“改善”或“恶化”的主要结果。良好结局定义为术后6个月mMCs分级为I/II级。
在登记的841例患者中，658例年轻患者（78.2%）和183例老年患者（21.8%）在术后6个月使用mMCs进行评估。老年患者术前mMCs分级的中位数显著差于年轻患者。两组之间“改善”率和“恶化”率均无显著差异（28.1%对25.1%；粗比值比[cOR]，0.86；95%置信区间[CI]，0.59 - 1.25；调整后比值比[aOR]，0.84；95% CI，0.55 - 1.28；16.9%对23.0%；cOR，1.47；95% CI，0.98 - 2.20；aOR，1.28；95% CI，0.83 - 1.97）。在单因素分析中，老年患者良好结局明显较少见，但在多因素分析中无显著差异（66.4%对53.0%；cOR，0.57；95% CI，0.41 - 0.80；aOR，0.77；95% CI，0.50 - 1.19）。在年轻和老年患者中，术前mMCs均能准确预测良好结局。
仅年龄本身并非禁止IMSCT手术的充分理由。
