To analyze the clinical characteristics and risk factors affecting survival of patients with high-grade spinal cord astrocytoma.

A retrospective analysis was conducted on the clinical data of 96 patients of spinal cord high-grade astrocytoma (WHO grade 3/4) who underwent surgical treatment at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from March 2011 to December 2021. The Kaplan-Meier method was used to estimate the survival period and survival rate; the log-rank test was used to analyze the effects of age, sex, course of disease, tumor location, length of involved vertebral segments, resection degree, WHO grade, H3K27M mutation and postoperative adjuvant radiotherapy and chemotherapy on survival period. Some of the above indicators (P<0.10) were included in the multivariate Cox regression model for analysis.

The median age of the 96 patients was 35 years old (7-63 years old), and 58.3% (56) of the patients were 18-45 years old; the median duration of the disease was 5.5 months (1-60 months), and 67.7% (65 cases) of the patients had the duration of disease which was ≤ 6 months. Tumors were more likely to occur in cervical enlargement (34.4%, 33 cases) and conus medullaris (30.2%, 29 cases) of the spinal cord. The median number of the vertebral segments involved with tumor was 3 (1-9) and 51.3% (51 cases) of the patients had the tumor resection degree of ≥50%. Those with WHO grade 4 accounted for 81.3% (78 cases), and those with H3K27M gene mutation accounted for 75.0% (72 cases). The median follow-up time was 50.5 months (range: 2.7-133.0 months), 8 patients (8.3%) were lost to follow-up, and 22 patients (23%) survived at the last follow-up. The overall median survival time was 18.6 months, and the 1-, 2-, and 5-year survival rates were 64%, 48%, and 15%, respectively. The results of log-rank test showed that patients with the tumor length of > 3 vertebral segments, WHO grade 4 tumor and tumor resection degree of < 50% had shorter survival time (all P<0.05). The patient′s age, gender, disease duration, tumor location, postoperative adjuvant radiotherapy or chemotherapy had little effect on the patient′s survival (all P>0.05). Multivariate regression Cox analysis showed that WHO grade 4 (HR=2.56, 95%CI: 1.01-6.50, P=0.047) and tumor length of > 3 vertebral segments (HR=1.99, 95%CI: 1.16-3.42, P=0.024) were independent risk factors for poor outcomes of patients.

The findings suggest that high-grade astrocytomas of the spinal cord have some unique clinical and biological features. The overall prognosis of patients is poor, and the prognosis of patients with WHO grade 4 and tumor length of > 3 vertebral segments seems even worse.

Spinal cord neoplasms; Gliomas; Disease attributes; Prognosis; Risk factors