Clinical Prognostic Factors and Molecular Characteristics of Spinal Cord Diffuse Midline Gliomas

BACKGROUND AND OBJECTIVE: Spinal cord diffuse midline glioma (DMG) is an extremely rare and aggressive tumor, characterized by a poor prognosis. While sharing similarities with brain DMGs, spinal cord DMGs may exhibit distinct clinical and prognostic features. Recognizing these differences is crucial for developing effective treatment strategies tailored to spinal cord DMGs. The objective of this analysis was to evaluate the survival prognosis and the influencing factors associated with spinal cord DMGs. METHODS: This study describes the clinical and molecular features of 46 patients with spinal cord DMG. The prognostic value of these clinical and molecular characteristics was investigated using Cox regression analysis and Kaplan-Meier curves. RESULTS: The average age at diagnosis was 30 ± 14 years, with male-to-female ratio close to 2.1:1. The median survival time of patients was 16.5 months. Tumors predominantly occur in the thoracic spine, and they exhibited a notably superior prognosis than those in other locations ( P = .009). The survival rate of patients undergoing radical resection tended to increase ( P = .003). In addition, patients undergoing a second surgery demonstrated a significant increase in survival rates ( P = .022). Median survival varied among histological grades: 43 months for grade II, 16 months for grade III, and 12 months for grade IV. Patients with histological grade IV had significantly worse prognosis than those with grades II and III ( P < .001). Thoracic ( P = .001) and thoracolumbar ( P = .017) segments and gross total resection ( P = .018) exhibited significantly higher survival rates for patients with histological grades II and III tumor, whereas none were observed for patients with histological grade IV tumor. CONCLUSION: We conducted an analysis of the clinical and molecular features of 46 patients with spinal cord DMG, exploring their prognostic value. This study aims to provide evidence for evidence-based treatment strategies for spinal cord DMG.