Prognostic factors and nomogram prediction of survival probability in primary spinal cord astrocytoma patients

OBJECTIVE Knowledge on the management of spinal cord astrocytoma (SCA) remains scarce. Here, the authors constructed and validated a predictive nomogram, often used for individualized prognosis and evaluations, to estimate cancer-specific survival (CSS) and overall survival (OS) for patients with SCA. METHODS Epidemiological characteristics were compared between low-grade SCA (LGSCA) and high-grade SCA (HGSCA) patients from the Surveillance, Epidemiology, and End Results (SEER) database. Risk factors for CSS and OS were determined using univariate and multivariate analyses and Kaplan-Meier curves. A nomogram was developed to individually predict the 3-, 5-, and 10-year CSS and OS rates. The clinical usefulness of the nomogram was assessed using calibration plots, the concordance index (C-index), and time-dependent receiver operating characteristic curves. RESULTS A total of 468 LGSCA and 165 HGSCA patients were eligible for inclusion. LGSCA and HGSCA patients demonstrated differences in age, tumor extension, insurance status, adjuvant treatment, and survival. Multivariate analysis demonstrated that in the LGSCA group, tumor extension, surgery type, and adjuvant therapy were individually associated with CSS. The distance of tumor extension and WHO grade were individually associated with CSS in the HGSCA group. The prognostic variables were further demonstrated using the Kaplan-Meier method, which also suggested that adjuvant treatment provided no advantage to HGSCA patients. A nomogram was constructed, and the C-index for CSS was 0.84 by internal validation (95% CI 0.79–0.90). CONCLUSIONS This research suggests that the distance of tumor extension, type of surgery, and adjuvant therapy are significant risk factors for CSS using multivariate analysis in the LGSCA group. Adjuvant treatment provided no advantages for CSS or OS in patients with HGSCAs. The nomogram may be clinically useful to healthcare providers.

A comprehensive model including preoperative peripheral blood inflammatory markers for prediction of the prognosis of diffuse spinal cord astrocytoma following surgery

Purpose 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. Methods 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. Results 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. Conclusion We successfully constructed a comprehensive prognostic model including preoperative peripheral blood inflammatory markers, which can stratify diffuse spinal cord astrocytoma into 4 subgroups.

Thoraco-lumbar high grade spinal cord astrocytoma: first documented case in a tertiary medical center and review of literature

<p class="abstract">This presents the first documented case of high grade spinal cord astrocytoma in a pediatric patient treated at a tertiary medical center and gives a comprehensive review of literature on the most current modes of diagnosis, treatment, and prognosis. We report the case of a 7-year-old male with complaints of inability to ambulate and associated low back pain, which rapidly deteriorated to complete paraplegia. Magnetic resonance imaging (MRI) of his spine revealed an intradural intramedullary spinal cord lesion extending from T11 to L5 vertebra, with considerations of spinal astrocytoma and ependymoma. The patient underwent en bloc laminectomy on T9-L3, partial resection of the intramedullary cord tumor, and subsequent laminoplasty with mini plates and screws. Histopathologic studies showed spinal cord astrocytoma, World Health Organization (WHO) grade 3 (anaplastic type). The patient’s neurologic status did not improve after the surgery and was advised to undergo chemo-radiation therapy but was lost to follow up. Ten months post-operation, patient sought consult due to severe back pain, generalized body weakness, and difficulty of breathing and was then admitted. Patient’s condition worsened that eventually resulted to his demise.</p><p class="abstract"> </p>

Rare Cases of IDH1 Mutations in Spinal Cord Astrocytomas

A low occurrence rate of spinal cord gliomas (4.3% of primary and glial CNS tumors) and the associated difficulties in building statistically significant cohorts of patients considerably slow down the development of effective approaches to the treatment of spinal cord tumors compared to brain tumors. Despite our extensiveknowledge regardingIDHmutations in intracranial tumors, mutations of this gene in spinal cord astrocytomas remain poorly understood. In thisstudy, we report on five cases of identified mutations in theIDH1gene in spinal cord astrocytoma cells, two of which are unique, as they have never been previously described in CNS gliomas.

Rare Cases of IDH1 Mutations in Spinal Cord Astrocytomas

A low occurrence rate of spinal cord gliomas (4.3% of primary and glial CNS tumors) and the associated difficulties in building statistically significant cohorts of patients considerably slow down the development of effective approaches to the treatment of spinal cord tumors compared to brain tumors. Despite our extensiveknowledge regardingIDHmutations in intracranial tumors, mutations of this gene in spinal cord astrocytomas remain poorly understood. In thisstudy, we report on five cases of identified mutations in theIDH1gene in spinal cord astrocytoma cells, two of which are unique, as they have never been previously described in CNS gliomas.