1Department of Neurosurgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime.
2Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi.
J Neurosurg Spine. 2024 Sep 20;41(6):699-707. doi: 10.3171/2024.5.SPINE24457. Print 2024 Dec 1.
Primary spinal cord gliomas are rare, and among these astrocytomas (WHO grade II) are much rarer. The optimal treatment strategy thus remains unclear. The authors conducted a multicenter study led by the Neurospinal Society of Japan (NSJ) to analyze treatment policies and outcomes. The aim was to present optimal treatment methods for spinal cord astrocytoma and to identify predictors of better outcomes.
Among 1033 consecutive cases of spinal cord intramedullary tumors treated surgically at 58 centers affiliated with the NSJ, 57 patients were diagnosed with diffuse astrocytoma (WHO grade II) and were enrolled in the present study. Among these 57 patients, treatment methods, outcomes, and tumor proliferation rate as evaluated by the MIB-1 staining index (SI) were analyzed, and the optimal treatment method for spinal cord astrocytomas (grade II) was determined. In addition, the authors searched for factors predicting better treatment outcomes.
Treatment for spinal cord astrocytoma comprised three methods: surgery alone in 30 patients, adjuvant radiation therapy in 13 patients, and adjuvant chemoradiotherapy in 13 patients. One patient who did not undergo surgery was excluded from survival analysis. Treatment with surgery alone or surgery with radiotherapy was associated with significantly longer overall and progression-free survivals than that with adjuvant chemoradiotherapy. Patients treated with radiation therapy had a higher MIB-1 SI than those treated with surgery alone. The extent of tumor resection tended to correlate with longer survival. In contrast, postoperative neurological worsening showed the inverse order. Adjuvant chemoradiotherapy was associated with the shortest survival in both total cases and recurrent cases. The optimal cutoff value of MIB-1 SI for predicting longer survival by surgery alone was less than 4.0%.
The optimal treatment for spinal cord astrocytoma is maximal tumor resection without neurological impairment. When some tumor remains in patients with an MIB-1 SI less than 4.0%, a wait-and-see approach is optimal. If the MIB-1 SI is higher than 4.0%, local radiation therapy is recommended. Adjuvant chemotherapy is not recommended for the treatment of grade II spinal cord astrocytoma.
原发性脊髓神经胶质瘤较为罕见，其中星形细胞瘤（WHO 分级 II 级）更为罕见。因此，最佳治疗策略仍不明确。作者进行了一项由日本神经脊柱学会（NSJ）牵头的多中心研究，以分析治疗策略和结果。旨在为脊髓星形细胞瘤提供最佳治疗方法，并确定更好结局的预测因素。
在 NSJ 下属 58 个中心对 1033 例连续脊髓髓内肿瘤患者进行手术治疗，其中 57 例诊断为弥漫性星形细胞瘤（WHO 分级 II 级），并纳入本研究。对这 57 例患者的治疗方法、结局和 MIB-1 染色指数（SI）评估的肿瘤增殖率进行分析，并确定脊髓星形细胞瘤（II 级）的最佳治疗方法。此外，作者还寻找了预测更好治疗结局的因素。
脊髓星形细胞瘤的治疗方法包括 3 种：单纯手术 30 例，辅助放疗 13 例，辅助放化疗 13 例。1 例未行手术患者被排除在生存分析之外。单纯手术或手术加放疗治疗的总生存期和无进展生存期均明显长于辅助放化疗。接受放疗的患者 MIB-1 SI 高于单纯手术组。肿瘤切除范围与生存时间呈正相关，而术后神经功能恶化呈负相关。辅助放化疗与总病例和复发病例的最短生存时间相关。单纯手术时预测生存时间较长的最佳 MIB-1 SI 截断值小于 4.0%。
脊髓星形细胞瘤的最佳治疗方法是在不损害神经功能的情况下最大限度地切除肿瘤。对于 MIB-1 SI 小于 4.0%的患者，残留少量肿瘤时可采用等待观察策略。如果 MIB-1 SI 高于 4.0%，则推荐局部放疗。不推荐辅助化疗治疗 II 级脊髓星形细胞瘤。
