Shorter survival time of adolescents and young adult patients than older adults with spinal cord glioblastoma: a multicenter study
Authors: Inoue Tomoo , Endo Toshiki , Muto Jun , Umebayashi Daisuke , Mitsuhara Takafumi , Shigekawa Seiji , Kanematsu Ryo , Iwasaki Motoyuki , Takami Toshihiro , Hida Kazutoshi , Mizuno Masaki , _ _ , _ _ , Hara Masahito , Aoyama Masahiro , Sugawara Taku , Shimizu Hiroaki , Ogihara Kotaro , Sugawara Atsushi , Kim Pho , Itoki Kazushige , Matsui Seiji , Kunihiro Noritsugu , Naito Kentaro , Yamamoto Shinji , Yasuhara Takao , Miyoshi Yasuyuki , Hayashi Hideki , Noriyuki Nakayama , Iwama Toru , Nakagawa Hiroshi , Sumiyoshi Manabu , Hijikata Yasukazu , Uchikado Hisaaki , Fukuda Hitoshi , Nakai Tomoaki , Sasayama Takashi , Mishima Kazuhiko , Yano Shunsuke , Sasamori Toru , Mikuni Nobuhiro , Akiyama Yukinori , Hara Tsuyoshi , Gondo Gakuji , Yoshida Mitsuhiro , Komatani Hideki , Takahashi Yuichi , Goto Hisaharu , Yasuhiro Node , Watanabe Mizuki , Ito Yasunobu , Hirano Yoshitaka , Tominaga Teiji , Takami Hirokazu , Karakama Jun , Ohashi Hiroki , Harada Naoyuki , Shingo Tetsuro , Kawajiri Satoshi , Yamauchi Tomohiro , Uno Tetsuji , Takai Keisuke , Fujimoto So , Otake Yasufumi , Takeshima Yasuhiro , Nakase Hiroyuki , Saito Akihiko , Morimoto Daijiro , Kim Kyongsong , Ohtonari Tatsuya , Kageyama Hiroto , Kuromi Yosuke , Takahashi Toshiyuki , Inoue Tatsushi , Seki Toshitaka , Yamazaki Kazuyoshi , Koyanagi Izumi , Yoshifuji Kazuhisa , Fujimoto Masashi , Nishikawa Misao , Yagi Takashi , Kinouchi Hiroyuki , Murata Hidetoshi , Kitayama Mari 
Published: November 2023

OBJECTIVE
Cancers in adolescents and young adults (AYAs) (age 15–39 years) often present with unique characteristics and poor outcomes. To date, spinal cord glioblastoma, a rare tumor, remains poorly understood across all age groups, including AYAs. This comparative study aimed to investigate the clinical characteristics and outcomes of spinal cord glioblastoma in AYAs and older adults (age 40–74 years), given the limited availability of studies focusing on AYAs.

METHODS
Data from the Neurospinal Society of Japan’s retrospective intramedullary tumor registry (2009–2020) were analyzed. Patients were dichotomized on the basis of age into AYAs and older adults. Univariate and multivariate Cox proportional hazards regression models were utilized to explore risk factors for overall survival (OS).

RESULTS
A total of 32 patients were included in the study, with a median (range) age of 43 (15–74) years. Of these, 14 (43.8%) were AYAs and 18 (56.2%) were older adults. The median OS was 11.0 months in AYAs and 32.0 months in older adults, and the 1-year OS rates were 42.9% and 66.7%, respectively, with AYAs having a significantly worse prognosis (p = 0.017). AYAs had worse preoperative Karnofsky Performance Status (KPS) than older patients (p = 0.037). Furthermore, AYAs had larger intramedullary tumors on admission (p = 0.027) and a significantly higher frequency of intracranial dissemination during the clinical course (p = 0.048). However, there were no significant differences in the degrees of surgical removal or postoperative radiochemotherapy between groups. The Cox proportional hazards regression model showed that AYAs (HR 3.53, 95% CI 1.17–10.64), intracranial dissemination (HR 4.30, 95% CI 1.29–14.36), and no radiation therapy (HR 57.34, 95% CI 6.73–488.39) were risk factors for mortality for patients of all ages. Worse preoperative KPS did not predict mortality in AYAs but did in older adults. The high incidence of intracranial dissemination may play an important role in the poor prognosis of AYAs, but further studies are needed.

CONCLUSIONS
The clinical characteristics of AYAs with spinal cord glioblastoma differ from those of older adults. The prognosis of AYAs was clearly worse than that of older adults. The devastating clinical course of spinal glioblastoma in AYAs was in line with those of other cancers in this age group.