This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Background and Objectives Primary spinal glioblastoma (PsGBM) is extremely rare. The dramatic neurologic deterioration and unresectability of PsGBM makes it a particularly disabling malignant neoplasm. Because it is a rare and heterogeneous disease, the assessment of prognostic factors remains limited.
Methods PsGBMs were identified from the French Brain Tumor Database and the Club de Neuro-Oncologie of the Société Française de Neurochirurgie retrospectively. Inclusion criteria were age 18 years or older at diagnosis, spinal location, histopathologic diagnosis of newly glioblastoma according to the 2016 World Health Organization classification, and surgical management between 2004 and 2016. Diagnosis was confirmed by a centralized neuropathologic review. The primary outcome was overall survival (OS). Therapeutic interventions and neurologic outcomes were also collected.
Results Thirty-three patients with a histopathologically confirmed PsGBM (median age 50.9 years) were included (27 centers). The median OS was 13.1 months (range 2.5–23.7), and the median progression-free survival was 5.9 months (range 1.6–10.2). In multivariable analyses using Cox model, Eastern Cooperative Oncology Group (ECOG) performance status at 0–1 was the only independent predictor of longer OS (hazard ratio [HR] 0.13, 95% CI 0.02–0.801; p = 0.02), whereas a Karnofsky performance status (KPS) score <60 (HR 2.89, 95% CI 1.05–7.92; p = 0.03) and a cervical anatomical location (HR 4.14, 95% CI 1.32–12.98; p = 0.01) were independent predictors of shorter OS. The ambulatory status (Frankel D–E) (HR 0.38, 95% CI 0.07–1.985; p = 0.250) was not an independent prognostic factor, while the concomitant standard radiochemotherapy with temozolomide (Stupp protocol) (HR 0.35, 95% CI 0.118–1.05; p = 0.06) was at the limit of significance.
Discussion Preoperative ECOG performance status, KPS score, and the location are independent predictors of OS of PsGBMs in adults. Further analyses are required to capture the survival benefit of concomitant standard radiochemotherapy with temozolomide.
Glossary
- CT=
- chemotherapy;
- ECOG=
- Eastern Cooperative Oncology Group;
- FBTDB=
- French Brain Tumor Database;
- FLAIR=
- fluid-attenuated inversion recovery;
- FU=
- follow-up;
- GBM=
- glioblastoma;
- HR=
- hazard ratio;
- IDH=
- isocitrate dehydrogenase;
- KPS=
- Karnofsky performance status;
- MGMT=
- O(6)-methylguanine-DNA methyltransferase;
- OS=
- overall survival;
- PFS=
- progression-free survival;
- PsGBM=
- primary spinal glioblastoma;
- RENOCLIP=
- Réseau de Neuro-Oncologie CLInico Pathologique;
- RENOP=
- Réseau de Neuro-oncologie pathologique;
- RT=
- radiotherapy;
- STR=
- subtotal resection surgery;
- TERT=
- telomerase reverse transcriptase;
- WHO=
- World Health Organization
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Associate Editor Rebecca Burch, MD.
- Received June 30, 2022.
- Accepted in final form December 5, 2022.
- © 2023 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
