Original ArticlePredictive Factors Determining the Overall Outcome of Primary Spinal Glioblastoma Multiforme: An Integrative Survival Analysis
Introduction
Intramedullary tumors are relatively uncommon among all central nervous system tumors, accounting for only 2–4% of the total. Ependymomas are the most common intramedullary tumors followed by astrocytoma. Spinal glioblastomas account for approximately 7.5% of all intramedullary gliomas, and barely 1.5% of all spinal tumors.1, 2 Patients within their first two decades of life3, 4, 5 tend to be more vulnerable to develop this type of tumor. The cervical spine is the most affected region—mainly the lower cervical spine—followed by the thoracic spine.4, 6, 7 Conus is a rare location for spinal glioblastoma multiforme (GBM). The treatment protocol for spinal cord glioblastoma is limited because of the scarcity of cases. The formal approach of spinal cord GBM consists of biopsy followed by radiotherapy (RT).8 Chemotherapy (CT) also plays a role in final outcomes as per various studies.9, 10 Because of the small number of cases in the literature featuring GBM and long-term survival, the assessment of the effects of prognostic factors on progression-free survival and overall survival is restricted. The aim of our study was to perform the integrative survival analysis by extracting individual patient data from the reported literature and elucidating more precisely the degree of association of the various factors with the survival outcome and to estimate the predictability of the overall survival (OS) by using Kaplan–Meier analysis.
Section snippets
Search Strategy
A systematic method was used to identify the relevant articles of English-language literature using the standard search string. The search was initiated inserting the key-term “spinal intramedullary malignant tumor” in PubMed, which generated 2108 articles published from 1938 to 2015. To conduct a comprehensive search, articles were further extracted by using key terms such “Primary spinal glioblastoma multiforme” and “Glioblastoma multiforme of spinal cord.” This second search generated 552
Results
The total number of cases published in the literature was 186 in 58 articles. Only 128 patients with primary spinal glioblastoma and complete information regarding the demographics, location of tumor, critical events (death), time to events, and treatment characteristics were selected for inclusion. Details about age, sex, and location were available in 126 (97.6%), 124 (96.1%), and 128 (100%) cases, respectively. The most common presenting symptom was limb weakness (50.4%), followed by sensory
Discussion
Intramedullary spinal cord tumors are rare and mainly composed of gliomas (80%), of which 60–70% are ependymomas and 30–40% are astrocytomas. Chamberlain et al.16 reported that 25% of spinal gliomas were high grade and associated with a poor survival rate. In general, the overall survival range for spinal GBM tends to be 12–24 months.22, 37, 63 Lam et al.64 found that the median survival for spinal GBM was 7 months in a population-based study. To our knowledge, the longest reported survival
Conclusions
The spinal cord is a rare site of GBM, which has a poor overall survival despite multimodality therapy. In this systemic analysis of spinal GBM, we found that surgery followed by RT and CT or surgery followed by RT alone had a significant effect on prolongation of life. The additional finding was improved OS in the adult group (18–65 years). This study did not find a statistically significant association between sex, tumor location, and extent of surgical resection on survival. For future
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