Abstract
BACKGROUND CONTENT
Diffuse gliomas of the spine (DGS)—consisting of intradural intramedullary glioblastoma,
astrocytoma, and oligodendroglioma—are exceedingly rare tumors that account for about
2% of primary spinal cord tumors. Much is unknown about their optimal treatment regimen
due to a relative lack of clinical outcome data.
PURPOSE
To provide an updated analysis on treatment and outcomes in DGS.
STUDY DESIGN/SETTING
Observational cohort study using The National Cancer Database (NCDB), a multicenter
prospectively collected oncology outcomes database. A systematic literature review
was also performed to compare the resulting data to previous series.
PATIENT SAMPLE
Patients with histologically confirmed DGS from 2004 to 2018.
OUTCOME MEASURES
Long-term overall survival and short-term 30/90-day postsurgical mortality, 30-day
readmission, and prolonged hospital length of stay.
METHODS
Impact of extent of resection and adjuvant therapy on overall survival was evaluated
using Kaplan–Meier estimates and multivariable Cox proportional hazards regression.
Univariate and multivariate logistic regression was used to analyze covariables and
their prognostic impact on short-term surgical outcomes.
RESULTS
Of the 747 cases that met inclusion criteria, there were 439 astrocytomas, 14 oligodendrogliomas,
and 208 glioblastomas. Sixty percent (n=442) of patients received radiation, and 45%
(n=324) received chemotherapy. Tumor histology significantly impacted survival; glioblastoma
had the poorest survival (median survival time [MS]: 12.3 months), followed by astrocytoma
(MS: 70.8 months) and oligodendroglioma (MS: 71.6 months) (p<.001). Gross total resection
(GTR) independently conferred a survival benefit in patients with glioblastoma (hazard
ratio [HR]: 0.194, p<0.001) and other WHO grade four tumors (HR: 0.223, p=.003). Adjuvant
chemotherapy also improved survival in patients with glioblastoma (HR: 0.244, p=.007)
and WHO grade four tumors (HR: 0.252, p<.001). Systematic literature review identified
14 prior studies with a combined DGS mortality rate of 1.3%, which is lower than the
4% real-world outcomes calculated from the NCDB. This difference may be explained
by selection biases in previously published literature in which only centers with
favorable outcomes publish their results.
CONCLUSIONS
There remains a paucity of data regarding treatment paradigms and outcomes for DGS.
Our analysis, the largest to date, demonstrates that GTR and adjuvant therapy independently
improve survival for certain high-grade subgroups of DGS. This best-available data
informs optimal management for such patients.
Keywords
Abbreviations:
CD score (Charlson-Deyo Comorbidity Score), CoC (Commission on cancer), DGS (Diffuse gliomas of the spine), EOR (Extent of resection), GTR (Gross total resection), HR (Hazard ratio), ICD-O-3 (International Classification of Diseases for Oncology Third Edition), IQR (Interquartile Range), LOS (Length of stay), MS (Median survival time), NCDB (National Cancer Database), OR (Odds ratio), STROBE (Strengthening the Reporting of Observational Studies in Epidemiology), STR (Subtotal resection), Surveillance (SEER, Epidemiology and end results), WHO (World Health Organization), OS1 (1-Year Estimated Overall Survival), 30M (30-day mortality), 30R (30-day readmission), 90M (90-day mortality), 95% CI (95% confidence interval)To read this article in full you will need to make a payment
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Chalif EJ, Foster C, Sack K, Patrick H, Mozaffari K, Rosner M. Impact of extent of resection and adjuvant therapy in diffuse gliomas of the spine [e-pub ahead of print]. Spine J. 2023. doi: 10.1016/j.spinee.2023.02.010.
Article info
Publication history
Published online: February 17, 2023
Accepted:
February 13,
2023
Received in revised form:
January 22,
2023
Received:
September 25,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
FDA device/drug status: Not applicable.
Author disclosures: EJC: Grants: GWU (B); Fellowship Support: NREF, ABTA, AOA (C). CF: Nothing to disclose. KS: Nothing to disclose. HP: Nothing to disclose. KM: Fellowship Support: ABTA (B). MR: Nothing to disclose.
This research did not receive any grant or funding from agencies in the public, commercial, or not-for-profit sectors. The authors declare no conflicts of interest. The NCDB is a joint project of the CoC of the American College of Surgeons and the American Cancer Society; The CoC's NCDB and the hospitals participating in the CoC's NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
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