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Clinical Factors for Prognosis and Treatment Guidance of Spinal Cord Astrocytoma

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Title: Clinical Factors for Prognosis and Treatment Guidance of Spinal Cord Astrocytoma
Authors: Seki, Toshitaka Browse this author
Hida, Kazutoshi Browse this author
Yano, Shunsuke Browse this author
Aoyama, Takeshi Browse this author
Koyanagi, Izumi Browse this author
Sasamori, Toru Browse this author →KAKEN DB
Hamauch, Shuji Browse this author
Houkin, Kiyohiro Browse this author →KAKEN DB
Keywords: Astrocytoma
Intramedullary tumor
Issue Date: Aug-2016
Publisher: Korean Society of Spine Surgery
Journal Title: Asian spine journal
Volume: 10
Issue: 4
Start Page: 748
End Page: 754
Publisher DOI: 10.4184/asj.2016.10.4.748
Abstract: Study Design: Retrospective study. Purpose: To obtain information useful in establishing treatment guidelines by evaluating baseline clinical features and treatment outcomes of patients with spinal cord astrocytoma (SCA). Overview of Literature: The optimal management of SCA remains controversial, and there are no standard guidelines. Methods: The study included 20 patients with low-grade and 13 with high-grade SCA surgically treated between 1989 and 2014. Patients were classified according to the extent of surgical resection. Survival was assessed using Kaplan-Meier plots and compared between groups by log-rank tests. Neurological status was defined by the modified McCormick scale and compared between groups by Mann-Whitney U tests. Results: Surgical resection was performed for 19 of 20 low-grade (95%) and 10 of 13 high-grade (76.9%) SCA patients. Only nine patients (27.3%) underwent gross total resection, all of whom had low-grade SCA. Of all patients, 51.5% showed deteriorated neurological status compared to preoperative baseline. Median overall survival was significantly longer for low-grade SCA than that for high-grade SCA (91 months, 78% at 5 years vs. 15 months, 31% at 5 years; p= 0.007). Low-grade SCA patients benefited from more aggressive resection, whereas high-grade SCA patients did not. Multivariate analysis revealed histology status (hazard ratio [HR], 0.30; 95% confidence interval [CI], 0.09-0.98; p< 0.05) and postoperative neurological status (HR, 0.12; CI, 0.02-0.95; p< 0.05) as independent predictors of longer overall survival. Adjuvant radiotherapy had no significant impact on survival rate. However, a trend for increased survival was observed with radiation cordotomy (RCT) in high-grade SCA patients. Conclusions: Aggressive resection for low-grade and RCT for high-grade SCA may prolong survival. Preservation of neurological status is an important treatment goal. Given the low incidence of SCA, establishing strong collaborative, interdisciplinary, and multiinstitutional study groups is necessary to define optimal treatments.
Type: article
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 関 俊隆

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