Age-related risk factors and treatment outcomes in geriatric patients with spinal low-grade glioma: A nationwide analysis

Background: Spinal low-grade glioma (SLGG) is a rare and aggressive central nervous system malignancy affecting all age groups. Elderly patients were known to have distinct disease manifestations and prognosis from younger adults, nevertheless, little is known about age-related differences within the geriatric population. This study aims to evaluate treatment modalities and outcomes across geriatric age groups, investigate age-related risk factors, and optimize clinical interventions that reinforce the unique characteristics of geriatric patients. Methods: Patients aged ≥ 65 years with WHO grade 1 and 2 spinal gliomas diagnosed between 2004 and 2017 were identified from the National Cancer Database (NCDB). Patients were stratified into four geriatric age groups: 65–70, 71–75, 76–80, and > 80 years. Baseline demographics, clinical characteristics, treatment modalities (surgery and radiation) and outcomes were analyzed. Kaplan-Meier survival analysis assessed overall survival (OS), and a multivariate Cox proportional hazards regression model identified independent risk factors for mortality. Results: A total of 119 geriatric SLGG patients were included: ages 65–70 (n = 51), 71–75 (n = 21), 76–80 (n = 32), and > 80 (n = 15). Demographic variables including sex, race, insurance status, and income quartile showed no significant differences across age groups (p > 0.05). However, Charlson-Deyo Comorbidity Classification (CDCC) scores differed significantly (p = 0.026), with a higher prevalence of scores ≥ 2 in the 76–80 age group. Five-year mortality rates varied significantly across age groups, with the highest observed in patients aged > 80 (93.3%) and the lowest in those aged 71–75 (42.9%, p = 0.017). Multivariate Cox regression identified age > 80 (HR = 2.96, 95% CI: 1.51–5.54, p = 0.002) and a CDCC score ≥ 2 (HR = 2.20, 95% CI: 1.19–4.06, p = 0.011) as independent predictors of increased mortality. Treatment modality and radiation dose did not significantly influence OS (p > 0.05). Conclusions: Age over 80 and increased comorbidity burden were independently associated with worse survival among geriatric SLGG patients, whereas surgery, radiation, and chemotherapy showed no differences in improving survival outcomes in this NCDB cohort.