Impact of surgery and radiation therapy on spinal high-grade gliomas: a population-based study.

ABSTRACT

INTRODUCTION: Spinal high-grade gliomas (S-HGGs) is an extremely rare entity in the literature, with only sporadic cases reported. We aim to characterize prognostic factors for post-treatment survival using the SEER database. METHODS: We examined all patients with gliomas located in the spinal cord. WHO-grade was first determined by site-specific factor-1 (WHO-grade), then supplemented by direct review of ICD-O-3 histology. Only grades 3 and 4 were included in this study. Multivariable Cox regression analysis was performed. RESULTS: A total of 158 high-grade spinal cord gliomas were included. Mean age at diagnosis was 36.88 years with 52.8% male. Median survival of all patients was 20 months. A stepwise Akaike information criterion was performed for multivariable Cox regression, with forced inclusion of surgery extent and postoperative radiation therapy (RT). The final model selection added tumor size in addition to these two variables. Tumor size was not related to survival in our study. The extend of surgery had no significant impact on survival of patients, whereas postoperative RT is associated with prolonged survival (HR = 0.55, CI [0.33, 0.93], p = 0.026). CONCLUSION: S-HGGs are rare tumors with aggressive course of disease. We have found that overall median survival of S-HGGs is poor at 24 months, and no demographic or tumor-related factors have been confirmed. Extend of surgery is not associated with improved survival after adjusting for postoperative RT. Postoperative RT is the only factor in our study associated with prolonged survival in S-HGGs.