Objective Primary spinal cord glioblastoma (PSCGBM) is a rare malignancy with a poor prognosis. To date, no prognostic nomogram for this rare disease was established. Hence, we aimed to develop a nomogram to predict overall survival (OS) of PSCGBM.
Methods Clinical data of patients with PSCGBM was retrospectively collected from the neurosurgery department of Soochow University Affiliated Second Hospital and the Surveillance Epidemiology and End Results database. Information including age, sex, race, tumor extension, extent of resection, adjuvant treatment, marital status, income, year of diagnosis and months from diagnosis to treatment were recorded. Univariate and multivariate Cox regression analyses were used to identify independent prognostic factors for PSCGBM. A nomogram was constructed to predict 1-year, 1.5-year, and 2-year OS of PSCGBM.
Results A total of 132 patients were included. The 1-year, 1.5-year, and 2-year OS were 45.5%, 29.5%, and 18.9%, respectively. Four variables: age groups, tumor extension, extent of resection, and adjuvant therapy, were identified as independent prognostic factors. The nomogram showed robust discrimination with a C-index value for the prediction of 1-year OS, 1.5-year OS, and 2-year of 0.71 (95% confidence interval [CI], 0.61–0.70), 0.72 (95% CI, 0.62–0.70), and 0.70 (95% CI, 0.61–0.70), respectively. The calibration curves exhibited high consistencies between the predicted and observed survival probability in this cohort.
Conclusion We have developed and internally validated a nomogram for predicting the survival outcome of PSCGBM for the first time. The nomogram has the potential to assist clinicians in making individualized predictions of survival outcome of PSCGBM.
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Objective Intramedullary spinal cord metastasis from lung cancer (ISCM-LC) are increasing in prevalence. We aim to investigate its clinical features, treatments and prognosis.
Methods We reported 6 ISCM-LC cases and conducted a systematic review. Descriptive summarization, survival analysis, and multivariate Cox regression analysis were performed to comprehensively study the disease.
Results All 6 patients had surgery. One used chemotherapy and the other had targeted drugs. Two patients died of ISCM-LC, 1 died of pulmonary embolism, 1 was alive, and 2 were lost to follow-up. We identified 197 ISCM-LC cases in literature with a mean age of 58 years and male preponderance. Small cell lung cancer accounted for 39.1%. The median interval from lung cancer to ISCM-LC was 7 months. Limb weakness was the most common symptom, and 45% cases progressed rapidly. Concomitant brain, leptomeningeal, and vertebral metastasis occurred to 55.8%, 20%, and 19.5%, respectively. Peritumoral edema appeared in 83.3%. Through survival analysis, we found sex, extraspinal metastasis, pathology, and improved symptoms affected the overall survival. Additionally, gross total resection (GTR) shared similar effectiveness with non-GTR, and other treatments following surgery hardly added extra effect. Surgery, improved symptoms, and sex were 3 independent prognostic factors after adjusting for confounding. The estimated median survival time was 5 months.
Conclusion The overall survival of ISCM-LC remains poor. Surgery is an independent protective factor for survival. Surgery should be considered once tolerated, and GTR might not be necessary. In addition, female patients with improved symptoms after intervention might have better overall survival.
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Objective To compare overall survival (OS) in patients with cervical spine metastases between initial radiotherapy followed by surgery and initial surgery followed by radiotherapy.
Methods The medical records of 36 patients with cervical spine metastases from January 2007 to December 2015 were retrospectively analyzed. These patients were divided into 2 groups. Group 1 included patients who underwent initial radiotherapy followed by surgery, while group 2 included patients who underwent initial surgery followed by radiotherapy. Clinical outcomes, OS, OS after cervical spine metastasis, and OS after surgery were analyzed in both groups. We evaluated whether primary tumor type, initial treatment modality, the modified Tomita score, Eastern Cooperative Oncology Group performance status, Karnofsky performance status, Japanese Orthopedic Association (JOA) score, Nurick grade, Frankel classification, and preoperative symptoms were associated with OS after cervical spine metastasis.
Results Both groups exhibited improvement in the postoperative visual analogue scale, but only group 2 showed a significant improvement in postoperative JOA score (p=0.03). OS did not differ significantly between groups. However, OS after cervical spine metastasis was only 7.0 months (95% confidence interval [CI], 4.8–9.3) in group 1 versus 15.8 months (95% CI, 8.8–24.0) in group 2, which represented a significant difference (p<0.05). Factors related to OS after cervical spine metastasis were primary tumor type, initial treatment modality, and preoperative symptoms (p<0.05). Patients who presented with only preoperative pain had approximately 3 fold longer OS after cervical spine metastasis than patients with preoperative motor weakness, even in group 2 (p<0.05).
Conclusion Surgical treatment prior to the onset of motor weakness or radiotherapy may be a good decision in case of cervical spine metastasis.
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