Predictive Factors Determining the Overall Outcome of Primary Spinal Glioblastoma Multiforme: An Integrative Survival Analysis

Abstract

Primary glioblastoma multiforme of the spinal cord is a rare entity. The aim of this study was to perform an integrative analysis of patients whose cases were selected from the published studies, and to examine the influence of various factors on overall outcomes. A PubMed search was performed for literature published from 1938 to 2015 to select the articles containing information about the demographics, tumor location, critical event (death), time to events, and treatment characteristics. One hundred twenty-eight cases of spinal glioblastoma were selected for analysis. Patients between 18 and 65 years of age had a better overall survival rate (14 months) compared with those of "extreme" age outside that range (<18 years, 10.5 months, and >65 years, 2 months; log-rank P = 0.0005). Univariate analysis showed age between 18 and 65 years (hazard ratio [HR] = 0.121; 95% confidence interval [CI] = 0.04-0.37; P = 0.0005) and surgery with radiotherapy (HR = 3.71; 95% CI = 1.36-10.13; P = 0.01) had a significant correlation with overall survival. In multivariate analysis, thoracic spine (odds ratio [OR] = 0.154; 95% CI = 0.033-0.717; P = 0.017) and conus (OR = 0.091; 95% CI = 0.010-0.798; P =0.030) tumor had a lesser chance for mortality at 6 months. Patients who received adjuvant therapy had a better median survival than those who had surgery (log-rank P = 0.0005). In this systemic analysis of primary spinal glioblastoma multiforme, we found that surgery followed by adjuvant therapy (radiotherapy, chemotherapy, or both) was significantly associated with improved survival. The additional finding was that overall median survival was better in the age group of 18-65 years (68 cases) compared with the extremes (<18 years, 53 cases; >65 years, 4 cases).