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Published on: February 22, 2015
Natural Course and Prognosis of Primary Spinal Glioblastoma: A Nationwide Study
Aymeric Amelot1, Louis-Marie Terrier2, Bertrand Mathon2
1From the Department of Neurosurgery (A.A., A.-R.C., I.Z.), CHRU de Tours; Department of Neurosurgery (L.-M.T., P.M.), Clairval Private Hospital, Ramsay Generale de Sante, Marseille; Department of Neurosurgery (B.M., M.K.), CHU Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris; Department of Neurosurgery (C.J.), HIA St Anne, Toulon; Department of Neurosurgery (T.P.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurosurgery A (V.J.), CHU Pellegrin, Bordeaux; Department of Neurosurgery (L.B.), Hôpital Saint Eloi-Gui de Chauliac, Montpellier; Department of Neurosurgery (F.B.), CHU d'Angers; Department of Neurosurgery (X.C.), CHU de St-Etienne, St Etienne; Department of Neurosurgery (L.C.), CHU Amiens-Picardie; Department of Neurosurgery (E.E.), CHU de Caen; Department of Neuropathology (D.F.-B.), La Timone, AP-HM, Marseille; Department of Pathology (G.G.), CHU Nancy, Nancy; Aix Marseille Univ (T.G.), INSERM, APHM, MMG, UMR1251, Marmara Institute, La Timone Hospital, Neurosurgery Departement, Marseille; Department of Pathology (A.J., E.U.-C.), Cancer University Institute of Toulouse Oncopole, CHU Toulouse; Department of Neurosurgery (S.K.), le Kremlin-Bicêtre, AP-HP, Kremlin-Bicêtre; Department of Neurosurgery (A.L.), CHU Grenoble-Alpes; Department of Neurosurgery (V.L.), CHU Rangueil, Toulouse; Department of Neuropathology (K.M.), Pitié-Salpêtrière, AP-HP, Paris; Department of Neuropathology (V. Rigau), CHU Gui de Chauliac, Montpellier; Department of Neurosurgery (V. Roualdes), CHU Laennec, Nantes; Department of Pathology (A.R.), CHU d'Angers; Department of Neurosurgery (R.S.), CHU de la Cavale Blanche, Brest; Department of Neurosurgery (J.V.), Pasteur Hospital, HCC, Colmar; and Department of Neurosurgery (J.P.), GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. aymmed@hotmail.fr.
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.
