Elsevier

World Neurosurgery

Volume 110, February 2018, Pages e715-e726
World Neurosurgery

Original Article
Expression of CD133 as a Putative Prognostic Biomarker to Predict Intracranial Dissemination of Primary Spinal Cord Astrocytoma

https://doi.org/10.1016/j.wneu.2017.11.089Get rights and content

Objective

Spinal cord astrocytoma with intracranial dissemination carries a poor prognosis. The mechanisms leading to dissemination remain to be elucidated. A stem cell marker, CD133, was reported to predict recurrence patterns in intracranial glioblastoma. We evaluated the significance of CD133 as a putative prognostic biomarker to predict intracranial dissemination in spinal cord astrocytoma.

Methods

This study included 14 consecutive patients with primary spinal cord astrocytoma treated from 1998 to 2014. Six of the patients were women and the patients' ages ranged from 12 to 75 years. Seven and 6 patients underwent open biopsy and partial resection of the tumors, respectively. After confirmation of the histologic diagnoses, all patients were treated with postoperative radiotherapy, chemotherapy, or a combination of both. To identify factors predictive of intracranial dissemination, we analyzed their clinical data including Ki-67 labeling index, and CD133 expression.

Results

Intracranial dissemination was observed in 6 of 14 patients. All 6 patients died during the follow-up period. Of the 8 patients without intracranial dissemination, 5 survived (P = 0.02). Median survival for the patients with intracranial dissemination was 22.7 months. CD133 expression was significantly higher in patients with intracranial dissemination (P = 0.04), whereas other variables did not indicate the dissemination.

Conclusions

The expression of CD133 can be an efficient biomarker to predict intracranial dissemination in spinal cord astrocytoma. Recognition of high CD133 expression in surgical specimens and early detection of intracranial dissemination is important for the clinical management of spinal cord astrocytoma.

Introduction

Intracranial dissemination has been reported to occur in primary spinal cord astrocytoma.1, 2 However, the clinical characteristics, predictive factors, and mechanisms underlying intracranial dissemination from primary spinal cord astrocytoma have not been fully established in case reports or other studies.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32

In this study, we first evaluated whether intracranial spreading of spinal cord astrocytoma would lead to devastating sequelae and affect outcomes.12, 23 Second, to elucidate a possible mechanism of intracranial dissemination from spinal cord astrocytoma, we analyzed CD133 immunohistochemistry. CD133, a cell surface marker of glioma stem cells,33, 34, 35 has been recognized as an indicator of poor prognosis in intracranial glioblastoma.36, 37 Our group recently reported that the expression of CD133 predicted the patterns and timings of recurrence in patients with primary intracranial glioblastoma.38 We thus speculated that the expression of CD133 in spinal cord astrocytoma might be related to the occurrence of intracranial dissemination.

In this study, we retrospectively evaluated 14 consecutive patients with primary spinal cord astrocytoma to clarify the characteristics and pathophysiology of intracranial dissemination from primary spinal cord astrocytoma. We especially evaluated CD133 immunohistochemistry to determine whether it could predict intracranial dissemination, hoping to establish a better management strategy for this clinical entity.

Section snippets

Study Design and Participants

This study was approved by the ethics committee of Tohoku University Graduate School of Medicine. Written informed consent was obtained from all patients. A retrospective study was conducted in the Department of Neurosurgery, Tohoku University Graduate School of Medicine in Sendai involving patients treated from January 1998 to April 2014. During this period, 14 consecutive patients were histologically diagnosed with spinal cord gliomas.

The clinical characteristics of the patients are

Patient Characteristics

The 14 patients with spinal cord astrocytoma consisted of 8 men (57%) and 6 women (43%). The median age was 48.5 years (range, 12–71 years), with 2 patients (14%) younger than 18 years. Initial presenting symptoms included motor weakness in 10 patients (71%), sensory loss in 4 (29%), pain in 3 (21%), and headache and nausea in 1 patient (7%). The mean length of symptoms before diagnosis was 7.5 months (range, 1–48 months). The preoperative median MMS score was 2 (range, 1–4), and that of

Discussion

Intramedullary spinal cord astrocytomas account for 6%–8% of spinal cord tumors.14, 28, 44 Intracranial dissemination from the spinal cord astrocytomas is rare; however, it could be a life-threatening event.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 Tumor disseminations are associated with various factors such as young age,26 high-grade glioma,12, 45 increment of Ki-67/MIB-1 LI,46 PTEN mutation,46 and immunosuppressed

Conclusions

We concluded that high CD133 expression predicts intracranial dissemination in primary spinal cord astrocytoma. Further evaluations are required to determine whether the recognition of high CD133 expression will improve the prognosis of this disease through the prediction and early detection of dissemination.

Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review.

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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