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  • Treatment and Survival for High-Grade Spinal Gliomas – A Surveillance, Epidemiology, and End Results (SEER) Study

    Final Number:

    Wuyang Yang MD, MS; Judy Huang MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: High grade spinal gliomas are an extremely rare entity in the literature. Only sporadic cases have been reported, and overall survival remains unclear. We aim to characterize post-treatment prognosis of these tumors with attempt to find factors influencing survival using the SEER database.

    Methods: We examined all patients with gliomas located in spinal cord or cauda equina. WHO-grade was first determined by site-specific factor 1(WHO-grade), then supplemented by direct review of ICD-O-3 histology. Only grade 3/4 were included in this study. Multivariable Cox regression analysis was performed. Due to small sample size, a step-wise Akaike information criterion(AIC) was performed for full model to select variables into an optimized multivariable model, with forced inclusion of treatment-related variables and variables that were significant in the full model.

    Results: A total of 165 high-grade spinal cord gliomas with 118 glioblastomas(GBM) were included. Mean age at diagnosis was 37.5 years with 36.8% male. Median survival of all patients was 25 months. The overall survival for 1-year, 2-year, 3-year is 71.3%, 51.2%, and 40.7%, respectively. A stepwise AIC was performed, with forced inclusion of patient age, tumor extension, surgery extent and postoperative radiation. The final model after step-wise AIC selection added tumor size in addition to these four variables. Distant tumor invasion(HR:1.74,p=0.043), GTR/TR(HR:2.38,p=0.037) were found to be significant risk factors, while postoperative radiation is a significant protective factor(HR:0.55,p=0.033). Age over 60(HR:1.73,p=0.072) and partial resection(HR:1.91,p=0.065) were borderline risk factors.

    Conclusions: Prognosis of high-grade spinal glioma is poor with median survival of 25 months. Distant tumor invasion and elderly age are risk factors for poor survival. Surgical resection is also a risk factor, which deserves further investigation. Post-operative radiation significantly improves survival and should be recommended.

    Patient Care: The characterization of overall survival and associated risk factors with this rare entity will improve the understanding of progression of this disease.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1. Understand the median and 2-year survival of spinal glioma patients 2. Understand that tumor extension is a significant risk factor in these patients 3. Understand that post-operative radiation therapy poses significant survival benefit in these patients


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