Prognostic factors in pediatric spinal cord astrocytoma

• Published in: Cancer 1998-12, Vol.83 (11), p.2391-2399
• Main Authors: Bouffet, Eric, Pierre‐Kahn, Alain, Marchal, Jean Claude, Jouvet, Anne, Kalifa, Chantal, Choux, Maurice, Dhellemmes, Patrick, Guérin, Jean, Tremoulet, Michel, Mottolese, Carmine
• Format: Article
• Language: English
• Subjects: Adolescent; Antineoplastic Agents - therapeutic use; Astrocytoma - radiotherapy; Astrocytoma - surgery; Astrocytoma - therapy; Biological and medical sciences; chemotherapy; Child; Child, Preschool; Combined Modality Therapy; Female; Humans; Infant; Male; Medical sciences; Multivariate Analysis; Neurology; Prognosis; prognostic factors; radiotherapy; Retrospective Studies; spinal cord astrocytoma; Spinal Cord Neoplasms - radiotherapy; Spinal Cord Neoplasms - surgery; Spinal Cord Neoplasms - therapy; surgery; Treatment Outcome; Tumors of the nervous system. Phacomatoses
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19981201)83:11<2391::AID-CNCR20>3.0.CO;2-0

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. Cancer 1998;83:2391‐2399. © 1998 American Cancer Society. This retrospective study of pediatric spinal cord astrocytomas emphasizes the role of histology and presenting symptoms as major factors influencing the outcome.