Retrospective cohort analysis.
To examine the effect of resection on survival and neurological outcome in a modern cohort of patients with spinal cord astrocytomas and identify prognostic factors for survival.
There are currently no clear treatment guidelines for the management of spinal cord astrocytomas. Additionally there is no conclusive evidence for the surgical resection of these tumors, with some studies even demonstrating worse survival with surgery. However, most studies have examined patients treated prior to the routine use of magnetic resonance imaging and advanced microsurgical techniques.
We performed a retrospective review of 46 consecutive patients with spinal cord astrocytomas treated at our institution from 1992 to 2012. Univariate and multivariate analyses were used to identify variables associated with survival.
The majority of patients (67.4%) underwent surgical resection, with the remaining only receiving biopsy. Of those who underwent resection, only 12.5% of patients underwent gross total resection, all of whom had low-grade astrocytomas. Of all patients, 30.7% worsened compared with their preoperative baseline. The occurrence of worsening increased with high tumor grade (52.9% vs. 27.6%, P = 0.086) and an increased extent of resection (66.7% vs. 18.8%, P = 0.0069). Resection did not provide a survival benefit compared with biopsy alone (P = 0.53). Multivariate analysis revealed high-grade histology (hazard ratio, 11.3; 95% confidence interval, 2.41–53.2; P = 0.0021), tumor dissemination (hazard ratio, 4.24; 95% confidence interval, 1.22–14.8; P = 0.023), and an increasing number of tumor involved levels (hazard ratio, 1.31; 95% confidence interval, 0.99–1.74; P = 0.058) to be associated with worse survival.
As surgical intervention is associated with a higher rate of neurological complications and lacks a clear benefit, the resection of spinal cord astrocytomas should be reserved for select cases and should be used sparingly.
Level of Evidence: 4
In this study, we have evaluated the effect of resection on neurological outcomes and survival of patients with spinal cord astrocytomas. As surgical intervention was associated with a higher incidence of neurological deficits while not conferring a survival advantage, resection should be reserved for select cases and be used sparingly.
From the Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC.
Address correspondence and reprint requests to Carlos A. Bagley, MD, Division of Neurosurgery, PO Box 3087, Duke University Medical Center, Durham, NC 27710; E-mail: firstname.lastname@example.org
Acknowledgment date: January 23, 2013. Revision date: December 3, 2013. Acceptance date: December 13, 2013.
The manuscript submitted does not contain information about medical device(s)/drug(s).
No funds were received in support of this work.
Relevant financial activities outside the submitted work: grants.