History of atopy confers improved outcomes in IDH mutant and wildtype lower grade gliomas.

PURPOSE: A history of atopy or allergy has been shown to be protective against the development of glioma, however the effect of atopy on patient outcomes, especially in conjunction with the survival benefit associated with IDH mutation, has not yet been investigated, and is the focus of the study we present here. METHODS: Low grade glioma (LGG) data from the TCGA was downloaded, along with IDH, TERT, 1p/19q and ATRX mutational status and genetic alterations. History of asthma, eczema, hay fever, animal, or food allergies, as documented in TCGA, was used to determine patient atopy status. Patients with missing variables were excluded from the study. RESULTS: 374 LGG studies were included. Patients with a history of atopy demonstrated longer overall survival (OS) compared to those without (145.3 vs. 81.5 months, p = 00.0195). IDH mutant patients with atopy had longer OS compared those without atopy (158.8 vs. 85 months, p = 0.035). Multivariate cox regression analysis demonstrated that the effects of atopy on survival were independent of IDH and histological grade, (p = 0.002, HR 0.257, 95% 0.109-0.604), (p = < 0.001, HR 0.217, 95% 0.107-0.444), and (p = 0.004, HR 2.72, 95% 1.373-5.397), respectively. In terms of treatment outcomes, patients with atopy did not differ in treatment response compared to their counterpart. Pathway analysis demonstrated an upstream activation of the BDNF pathway (p = 0.00027). CONCLUSION: A history of atopy confers a survival benefit in patients with diffuse low-grade glioma. Activation of the BDNF pathway may drive the observed differences.

Percutaneous fixation for the treatment of metastatic spinal disease provides effective symptom palliation with low rates of hardware failure.

BACKGROUND: The incidence of survival from metastatic spinal disease (MSD) continues to rise. However, open surgery for MSD is associated with significant perioperative morbidity, while minimally invasive percutaneous pedicle screw fixation (MIPPSF) offers reduced tissue trauma, less blood loss, and a reduction in complications. Lytic bone disease plus perioperative radiation further increase risk for instrument failure, especially in long construct MIPPSF. Here, we compared 6 short construct and 14 long construct outcomes for MIPPSF performed in MSD patients, including multiple myeloma (MM). METHODS: For 20 patients undergoing MIPPSF for MSD, we evaluated disease type, location, the extent of surgery, outcomes, and survival rates. Statistical comparisons were performed between long-segment construct and short-segment construct patients utilizing Kaplan-Meier survival curves, Mann-Whitney U, and Chi-squared tests. RESULTS: No instrument failure and comparable symptomatic relief were observed for both short and long MIPPSF constructs. However, long construct patients experienced; a higher incidence of postoperative complications, including screw loosening, but exhibited longer overall survivals (likely related to underlying type of MSD, with MM patients making up the largest portion of long construct patients). CONCLUSION: Long construct MIPPSF in MSD did not have increased risk of construct failure and offered effective symptomatic relief, including for MM patients, without introducing a greater risk construct instability.