Medical Student University of Pittsburgh School of Medicine Pittsburgh, PA, US
Disclosure(s):
Riya M. Dange, B.S.: No financial relationships to disclose
Introduction: Intramedullary spinal cord tumors (IMSCTs) are rare CNS neoplasms with few primary studies. Operative planning for IMSCT resections requires scrupulous balancing of morbidity and mortality risks, which are contingent on multiple perioperative variables. These decisions and goals-of-care discussions with patients are both limited by the dearth of evidence predicting adverse outcomes. After assembling a large cohort of IMSCT patients spanning 20 years and multiple tumor pathologies, we developed a prediction model for tumor recurrence in patients undergoing IMSCT resections.
Methods: Perioperative data were retrospectively collected on 138 patients who underwent IMSCT resections at UPMC hospitals between December 2001 and January 2020. Logistic regression models were generated for recurrence within the study period, 5 years of surgery, and 1 year of surgery. Predictors of interest included tumor pathology, extent of resection, age at surgery, tumor location, and biological sex. Models were optimized via stepwise backward regression and evaluated for fit, discrimination, and parsimony via goodness of fit tests, likelihood ratio tests, and area under the curve (AUC) for receiver operating curves.
Results: Tumor recurrence within the study period was significantly associated with age at surgery (p=0.00038), thoracolumbar location (p=0.00274), female sex (p=0.02), and ependymoma pathology (p=0.03). The final model had an AUC value of 0.7985, indicating good discrimination between patients with and without tumor recurrence. Tumor recurrence within 5 years of surgery was significantly associated with only thoracolumbar location (p=0.02). The final model had an AUC value of 0.7373, indicating adequate discrimination. Finally, tumor recurrence within 1 year of surgery was significantly associated with only ependymoma pathology (p=0.04). The final model had an AUC value of 0.7611, indicating adequate discrimination.
Conclusion : These preliminary prediction models for tumor recurrence in IMSCT resection patients demonstrate how perioperative factors must be weighted differently in predicting recurrence over distinct time periods. Although further refinement is required via meta-analyses and factor interaction testing, they represent an important step toward establishing accurate pre-operative mortality estimates for providers educating patients on IMSCT resection risks.