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Prognostic factors in pediatric spinal cord astrocytoma
E Bouffet1, A Pierre-Kahn, J C Marchal
1Department of Pediatric Oncology, Centre Léon Bérard, Lyon, France.
Insights
Prognosis for pediatric spinal cord astrocytoma is influenced by histology and time to diagnosis. Early detection and low-grade tumors improve outcomes in children with these rare spinal cord tumors.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Neurosurgery
Background:
- Management of pediatric spinal cord astrocytomas lacks clear optimization strategies.
- Understanding prognostic factors is crucial for effective treatment planning.
Purpose of the Study:
- To identify factors influencing the prognosis of pediatric spinal cord astrocytomas.
- To guide therapeutic strategies based on patient-specific features.
Main Methods:
- Retrospective review of 73 pediatric patients with spinal cord astrocytomas across 13 French centers.
- Analysis of hospital records, surgical data, and radiological investigations.
- Follow-up data available for 94% of patients.
Main Results:
- Low-grade histology (grades 1 or 2) was observed in 70% of patients.
- Independent prognostic factors identified: tumor histology (RR=7.69) and symptom-to-diagnosis interval (RR=4.93).
- Extent of surgery or radiotherapy did not significantly impact survival.
Conclusions:
- Histology and time to diagnosis are key determinants of prognosis in pediatric spinal cord astrocytoma.
- Findings aid in tailoring treatment strategies using clinical, radiological, and pathological data.
- Further research may refine management protocols for these pediatric tumors.
Background:
Factors that could optimize the management of pediatric spinal cord astrocytoma remain unclear and controversial.
Methods:
To determine the factors that influence the prognosis of pediatric patients with spinal cord astrocytomas, a series of 73 consecutive patients at 13 French treatment centers with histologically proven spinal cord astrocytomas was retrospectively reviewed. Hospital records, operative records, and results of radiologic investigations were available in all cases. Follow-up was achieved in 94% of cases.
Results:
Seventy percent of the patients had low grade (1 or 2) tumors. Total or subtotal surgical resection was achieved in 43%. Thirty-six patients were irradiated following surgery. Fifty-one patients were alive at a median follow-up of 54 months. Twenty-three patients relapsed. Univariate analysis showed that good outcome was correlated with male gender, age younger than 7 years, duration of presenting symptoms longer than 2 months, the presence of spinal deformities, and low grade histology, whereas sensory loss was associated with decreased survival. Multivariate analysis using the Cox proportional hazards model confirmed that histology (relative risk [RR] = 7.69) and the interval between first symptoms and diagnosis (RR = 4.93) were significant independent prognostic factors. The extent of surgery or radiotherapy had no clear influence on survival.
Conclusions:
This review sheds light on the prognoses of pediatric patients with spinal cord astrocytomas and may help to determine therapeutic strategies based on patients' clinical, radiologic, and pathologic features.