Deep Learning-Based Risk Calculator for 5-Year Survival Prediction in Spinal Low Grade Glioma: A Nationwide Analysis

Introduction: Spinal low grade glioma (LGG) is a type of slow-growing primary spine malignancy that affects both adults and pediatric patients. Despite distinct histopathology and disease manifestation, standardized managements are adopted clinically in these two populations, and the difference in prognosis remains poorly understood. This study aims to compare the treatment modalities and clinical outcomes of adult and pediatric patients and explore risk factors associated with mortality.

Methods: Patients with glioma graded 1 or 2 were identified from the National Cancer Data Base from 2004 to 2017 and were grouped into pediatric (age≤21 years) and adult (age>21 years) cohorts. Univariate and multivariate analyses were performed. The Kaplan-Meier survival analysis was used to analyze overall survival (OS).

Results: A total of 884 patients with spinal LGG were identified: 590 (66.7%) adult patients and 294 (33.3%) pediatric patients. Overall, pediatric patients harbored larger tumors (56.7 ± 81.8 mm3 vs 35.0 ± 26.0 mm3, p< 0.001), but with significantly better OS compared to adults (5-year mortality, 8.2% vs 36.8%, p< 0.001). Surgery, including both GTR and STR were the mainstay intervention, and improved OS in both populations (p=0.0015). A higher proportion of adults received radiation (47.8% vs 19.1%, p< 0.001), whereas a higher proportion of pediatric patients received chemotherapy (18.4% vs 11.7%, p=0.007), however, both therapies showed adverse effect to OS in both populations (p < 0.0001). Cox regression showed that pediatric patients were at a remarkably lower risk (HR=0.26, CI:0.17-0.41, p< 0.001). Surgery alone was associated with significantly lower risk (HR=0.43, p< 0.001), whereas chemotherapy was associated with elevated risk (HR=1.87, p< 0.001). Random survival forest model was found to be the most predictive model, confirmed by ROC analysis (AUC=0.74) and C-index test (C-index=0.71), with high CDCC scores, radiation as the sole treatment and larger CROWFLY distance being the most influential prognostic factors.

Conclusion : This study highlights the differences in treatment modalities and clinical outcomes between pediatric and adult LGG patients and pinpoints the necessity in multidisciplinary and age-specific consideration in treatment selection and prognosis prediction, to ultimately improve the clinical outcome for LGG patients.