title: A retrospective observational study on the treatment outcomes of 26 patients with spinal cord astrocytoma including two cases of malignant transformation.
abstract: To determine the biologic behavior and prognostic factors of spinal cord astrocytoma, we reviewed surgical and clinical outcomes. Due to the rarity of spinal cord astrocytoma, there is a lack of research regarding this type of tumor and malignant transformation.
  
  
  
  We retrospectively reviewed the data from all patients on whom we performed spinal cord tumor removal between 1983 and 2014. Twenty-six patients were pathologically confirmed to have spinal cord astrocytoma or glioblastoma. Surgical extent and disease progression were confirmed by the surgeon based on operative findings, postoperative MRI, and outpatient department (OPD) follow-up.
  
  
  
  Pain or neurological deficit was the chief complaint for all patients. With MRI studies, there is a tendency for high-grade astrocytomas to show as enhanced and heterogeneous images. Two of the low-grade astrocytomas showed malignant transformation over the course of 4 and 11 months, respectively. The overall survival (OS) for low-grade astrocytoma was 28-480 months (mean 156.38 months); the OS for high-grade astrocytoma was 1-36 months (mean 12.00 months).
  
  
  
  Two of 12 low-grade cases showed malignant transformations at 4 and 11 months, respectively, based on pathological confirmation. With spinal cord astrocytomas, enhanced MRI results appeared similar to those of a malignant lesion. We suggest close observation and image correlation of low-grade astrocytomas, even when pathologically confirmed as low-grade. In this review, we found that histologic grade is the most important prognostic factor, although it is not always concordant with biologic behaviors.
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211, Eonju-ro Gangnam-gu, Seoul, 135-720, South Korea.
authors.forename: Seong Jun
authors.initials: SJ
authors.lastname: Ryu
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211, Eonju-ro Gangnam-gu, Seoul, 135-720, South Korea.
authors.forename: Jong Yul
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211, Eonju-ro Gangnam-gu, Seoul, 135-720, South Korea.
authors.forename: Kyung Hyun
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211, Eonju-ro Gangnam-gu, Seoul, 135-720, South Korea.
authors.forename: Jeong Yoon
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211, Eonju-ro Gangnam-gu, Seoul, 135-720, South Korea.
authors.forename: Sung Uk
authors.initials: SU
authors.lastname: Kuh
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211, Eonju-ro Gangnam-gu, Seoul, 135-720, South Korea.
authors.forename: Dong Kyu
authors.initials: DK
authors.lastname: Chin
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211, Eonju-ro Gangnam-gu, Seoul, 135-720, South Korea.
authors.forename: Keun Su
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211, Eonju-ro Gangnam-gu, Seoul, 135-720, South Korea. yecho@yuhs.ac.
authors.forename: Yong Eun
authors.initials: YE
authors.lastname: Cho
authors.affiliation: Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. PAXCO@yuhs.ac.
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001416:Back Pain / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D019635:Neurosurgical Procedures / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Astrocytoma; Malignant glioma; Radiotherapy; Spinal cord neoplasm; Survival