Shorter survival time of adolescents and young adult patients than older adults with spinal cord glioblastoma: a multicenter study

Author:

Inoue Tomoo1,Endo Toshiki2,Muto Jun3,Umebayashi Daisuke4,Mitsuhara Takafumi5,Shigekawa Seiji6,Kanematsu Ryo7,Iwasaki Motoyuki8,Takami Toshihiro9,Hida Kazutoshi10,Mizuno Masaki11,_ _,_ _,Hara Masahito,Aoyama Masahiro,Sugawara Taku,Shimizu Hiroaki,Ogihara Kotaro,Sugawara Atsushi,Kim Pho,Itoki Kazushige,Matsui Seiji,Kunihiro Noritsugu,Naito Kentaro,Yamamoto Shinji,Yasuhara Takao,Miyoshi Yasuyuki,Hayashi Hideki,Noriyuki Nakayama,Iwama Toru,Nakagawa Hiroshi,Sumiyoshi Manabu,Hijikata Yasukazu,Uchikado Hisaaki,Fukuda Hitoshi,Nakai Tomoaki,Sasayama Takashi,Mishima Kazuhiko,Yano Shunsuke,Sasamori Toru,Mikuni Nobuhiro,Akiyama Yukinori,Hara Tsuyoshi,Gondo Gakuji,Yoshida Mitsuhiro,Komatani Hideki,Takahashi Yuichi,Goto Hisaharu,Yasuhiro Node,Watanabe Mizuki,Ito Yasunobu,Hirano Yoshitaka,Tominaga Teiji,Takami Hirokazu,Karakama Jun,Ohashi Hiroki,Harada Naoyuki,Shingo Tetsuro,Kawajiri Satoshi,Yamauchi Tomohiro,Uno Tetsuji,Takai Keisuke,Fujimoto So,Otake Yasufumi,Takeshima Yasuhiro,Nakase Hiroyuki,Saito Akihiko,Morimoto Daijiro,Kim Kyongsong,Ohtonari Tatsuya,Kageyama Hiroto,Kuromi Yosuke,Takahashi Toshiyuki,Inoue Tatsushi,Seki Toshitaka,Yamazaki Kazuyoshi,Koyanagi Izumi,Yoshifuji Kazuhisa,Fujimoto Masashi,Nishikawa Misao,Yagi Takashi,Kinouchi Hiroyuki,Murata Hidetoshi,Kitayama Mari

Affiliation:

1. Department of Neurosurgery, Saitama Red Cross Hospital, Saitama, Saitama, Japan;

2. Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan;

3. Department of Neurosurgery, Fujita Health University, Nagoya, Aichi, Japan;

4. Department of Neurosurgery, Kyoto Prefectural Hospital of Medicine, Kyoto, Kyoto, Japan;

5. Department of Neurosurgery, Hiroshima University Graduate School of Medicine, Hiroshima, Hiroshima, Japan;

6. Department of Neurosurgery, Ehime University, Ehime, Ehime, Japan;

7. Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan;

8. Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan;

9. Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Osaka, Osaka, Japan;

10. Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Hokkaido, Japan; and

11. Department of Minimum Invasive Neurospinal Surgery, Mie University, Mie, Mie, Japan

Abstract

OBJECTIVE Cancers in adolescents and young adults (AYAs) (age 15–39 years) often present with unique characteristics and poor outcomes. To date, spinal cord glioblastoma, a rare tumor, remains poorly understood across all age groups, including AYAs. This comparative study aimed to investigate the clinical characteristics and outcomes of spinal cord glioblastoma in AYAs and older adults (age 40–74 years), given the limited availability of studies focusing on AYAs. METHODS Data from the Neurospinal Society of Japan’s retrospective intramedullary tumor registry (2009–2020) were analyzed. Patients were dichotomized on the basis of age into AYAs and older adults. Univariate and multivariate Cox proportional hazards regression models were utilized to explore risk factors for overall survival (OS). RESULTS A total of 32 patients were included in the study, with a median (range) age of 43 (15–74) years. Of these, 14 (43.8%) were AYAs and 18 (56.2%) were older adults. The median OS was 11.0 months in AYAs and 32.0 months in older adults, and the 1-year OS rates were 42.9% and 66.7%, respectively, with AYAs having a significantly worse prognosis (p = 0.017). AYAs had worse preoperative Karnofsky Performance Status (KPS) than older patients (p = 0.037). Furthermore, AYAs had larger intramedullary tumors on admission (p = 0.027) and a significantly higher frequency of intracranial dissemination during the clinical course (p = 0.048). However, there were no significant differences in the degrees of surgical removal or postoperative radiochemotherapy between groups. The Cox proportional hazards regression model showed that AYAs (HR 3.53, 95% CI 1.17–10.64), intracranial dissemination (HR 4.30, 95% CI 1.29–14.36), and no radiation therapy (HR 57.34, 95% CI 6.73–488.39) were risk factors for mortality for patients of all ages. Worse preoperative KPS did not predict mortality in AYAs but did in older adults. The high incidence of intracranial dissemination may play an important role in the poor prognosis of AYAs, but further studies are needed. CONCLUSIONS The clinical characteristics of AYAs with spinal cord glioblastoma differ from those of older adults. The prognosis of AYAs was clearly worse than that of older adults. The devastating clinical course of spinal glioblastoma in AYAs was in line with those of other cancers in this age group.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

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