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Primary and metastatic glioblastoma of the spine in the pediatric population: a systematic review

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Abstract

Pediatric glioblastoma multiforme (GBM) involving the spine is an aggressive tumor with a poor quality of life for patients. Despite this, there is only a limited number of reports describing the outcomes of pediatric spinal GBMs, both as primary spinal GBMs and metastases from an intracranial tumor. Here, we performed an individual patient meta-analysis to characterize factors affecting prognosis of pediatric spinal GBM. MEDLINE, Embase, and the Cochrane databases were searched for published studies on GBMs involving the spine in pediatric patients (age ≤ 21 years old). Factors associated with the survival were assessed with multi-factor ANOVAs, Cox hazard regression, and Kaplan-Meier analyses. We extracted data on 61 patients with spinal GBM from 40 studies that met inclusion criteria. Median survival was significantly longer in the primary spinal GBM compared that those with metastatic GBM (11 vs 3 months, p < 0.001). However, median survival of metastatic GBM patients was 10 months following diagnosis of their primary brain tumor, which was not different from that of primary spinal GBM patients (p = 0.457). Among primary spinal GBM patients, chemotherapy (hazard ratio (HR) = 0.255 [0.106–0.615], p = 0.013) and extent of resection (HR = 0.582 [0.374–0.905], p = 0.016) conferred a significant survival benefit. Younger age (less than 14 years) was associated with longer survival in patients treated with chemotherapy than those who did not undergo chemotherapy (β = − 1.12, 95% CI [− 2.20, − 0.03], p < 0.05). In conclusion, survival after presentation of metastases from intracranial GBM is poor in the pediatric population. In patients with metastatic GBM, chemotherapy may have provided the most benefit in young patients, and its efficacy might have an association with extent of surgical resection.

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Author notes

  1. Runze Yang and Albert M. Isaacs contributed equally to this work.

Authors and Affiliations

  1. Cumming School of Medicine, University of Calgary, 3330 Hospital Drive N.W., Calgary, AB, Canada

    Runze Yang & Andrew P. Lapointe

  2. Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, USA

    Albert M. Isaacs

  3. Department of Clinical Neuroscience, Section of Neurosurgery, University of Calgary, Calgary, AB, Canada

    Albert M. Isaacs, Magalie Cadieux, Jay Riva-Cambrin & Clare N. Gallagher

  4. Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Tomas J. Hirmer

  5. Department of Neurological Surgery, Columbia University, New York, NY, USA

    Travis S. CreveCoeur

  6. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA

    Michael Opoku-Darko

  7. Libraries and Cultural Resources, University of Calgary, Calgary, AB, Canada

    Zahra Premji

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Appendix. Searches were run in December 4th, and references were downloaded in ris format and uploaded to Covidence for deduplication

Appendix. Searches were run in December 4th, and references were downloaded in ris format and uploaded to Covidence for deduplication

Table 2. Database(s): Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily 1946 to December 03, 2019
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Table 3. Database(s): Embase 1974 to 2019 December 03. Search strategy:
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Table 4. Database(s): EBM Reviews–Cochrane Database of Systematic Reviews 2005 to November 20, 2019. Search strategy:
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Table 5. Database(s): EBM Reviews–Cochrane Central Register of Controlled Trials October 2019. Search strategy:
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Yang, R., Isaacs, A.M., Cadieux, M. et al. Primary and metastatic glioblastoma of the spine in the pediatric population: a systematic review. Childs Nerv Syst 37, 1849–1858 (2021). https://doi.org/10.1007/s00381-021-05098-8

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