Medical Student University of Alabama at Birmingham
Introduction: Intramedullary spinal cord tumors (IMSCTs) are rare, challenging tumors, and the extent of resection may influence overall survival (OS). Gross total resection (GTR) is hypothesized to offer superior outcomes compared to subtotal resection (STR) or biopsy. This meta-analysis quantifies the impact of resection extent on OS in spinal gliomas.
Methods: A systematic review was conducted by two independent reviewers using databases such as PubMed, Scopus, and Embase. Studies reporting OS in patients who underwent GTR, STR, or biopsy for spinal gliomas were included. Random-effects models were used to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses were performed for astrocytomas and glioblastomas. Heterogeneity was assessed using I² and Cochran’s Q test. Funnel plot asymmetry tests evaluated publication bias.
Results: In the overall analysis of 12 studies, GTR was associated with a significant improvement in OS compared to STR or biopsy, with a pooled HR of 1.96 (95% CI: 1.18, 3.25, p = 0.0089), indicating nearly twice the survival rate for GTR patients. Moderate heterogeneity was detected (I² = 49.08%, Q = 22.43, p = 0.0213). In the astrocytoma subgroup (k = 6), GTR showed a trend towards improved OS with an HR of 2.11 (95% CI: -0.1667, 1.6565), though this did not reach statistical significance (p = 0.1092). High heterogeneity (I² = 77.15%, p = 0.0053) was observed. For glioblastomas (k = 3), no significant survival difference was noted between GTR and STR/biopsy (HR = 1.49, 95% CI: -0.5181, 1.3195, p = 0.3927), with no heterogeneity (I² = 0%).
Conclusion : Gross total resection significantly improves OS in patients with spinal gliomas, particularly in astrocytomas, though substantial variability among astrocytoma studies warrants further investigation. For glioblastomas, GTR did not confer a significant survival advantage. These findings support GTR as a goal in spinal glioma surgeries when feasible.