Syed I Khalid1, Owoicho Adogwa2, Ryan Kelly3, Ankit Metha4, Carlos Bagley5, Joseph Cheng6, John O'Toole1. 1. Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois. 2. Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois. Electronic address: owoicho.adogwa@gmail.com. 3. Georgetown University School of Medicine, Washington, D.C. 4. Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois. 5. Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas. 6. Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio.
Abstract
OBJECTIVE: In adults, spinal ependymomas constitute only 3% to 6% of central nervous system tumors. Because of their rarity and poor prognosis, large population-based studies are needed to assess the epidemiology and survival risk factors associated with these tumors in the hope of improving outcome. The authors undertook this retrospective study to explore factors that may influence survival in adult patients with spinal ependymomas. METHODS: Using the Surveillance, Epidemiology, and End Results database, a prospective cancer registry, the authors retrospectively assessed survival in histologically confirmed spinal ependymomas in patients 18 years of age and older. Survival was described with Kaplan-Meier curves, and a multivariate regression analysis was used to assess the association of several variables with survival while controlling for confounding variables. RESULTS: Overall survival at 1 year, 3 years, and 5 years after diagnosis was 97.0%, 94.3%, and 93.3%, respectively. Patient age at diagnosis (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.04-1.07, P < 0.001), tumor grade IV (HR 11.11, 95% CI 1.27-97.02, P = 0.032), and the use of radiation therapy during the course of treatment (HR 4.42, 95% CI 1.69-11.57, P = 0.003) were each associated with decreased survival. Gross total resection (HR 0.42, 95% CI 0.20-1.10, P = 0.026) was associated with improved overall survival. Gender, tumor size, and tumor extension were not found to impact survival. CONCLUSIONS: High-grade ependymomas occurring in the spine have a much worse prognosis than do those with lower grades. Early diagnosis and surgery appear to be associated with improved survival and outcomes, whereas radiation therapy has an unclear role.
OBJECTIVE: In adults, spinal ependymomas constitute only 3% to 6% of central nervous system tumors. Because of their rarity and poor prognosis, large population-based studies are needed to assess the epidemiology and survival risk factors associated with these tumors in the hope of improving outcome. The authors undertook this retrospective study to explore factors that may influence survival in adult patients with spinal ependymomas. METHODS: Using the Surveillance, Epidemiology, and End Results database, a prospective cancer registry, the authors retrospectively assessed survival in histologically confirmed spinal ependymomas in patients 18 years of age and older. Survival was described with Kaplan-Meier curves, and a multivariate regression analysis was used to assess the association of several variables with survival while controlling for confounding variables. RESULTS: Overall survival at 1 year, 3 years, and 5 years after diagnosis was 97.0%, 94.3%, and 93.3%, respectively. Patient age at diagnosis (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.04-1.07, P < 0.001), tumor grade IV (HR 11.11, 95% CI 1.27-97.02, P = 0.032), and the use of radiation therapy during the course of treatment (HR 4.42, 95% CI 1.69-11.57, P = 0.003) were each associated with decreased survival. Gross total resection (HR 0.42, 95% CI 0.20-1.10, P = 0.026) was associated with improved overall survival. Gender, tumor size, and tumor extension were not found to impact survival. CONCLUSIONS: High-grade ependymomas occurring in the spine have a much worse prognosis than do those with lower grades. Early diagnosis and surgery appear to be associated with improved survival and outcomes, whereas radiation therapy has an unclear role.
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Authors: David R Ghasemi; Martin Sill; Konstantin Okonechnikov; Andrey Korshunov; Stephen Yip; Peter W Schutz; David Scheie; Anders Kruse; Patrick N Harter; Marina Kastelan; Marlies Wagner; Christian Hartmann; Julia Benzel; Kendra K Maass; Mustafa Khasraw; Ronald Sträter; Christian Thomas; Werner Paulus; Christian P Kratz; Hendrik Witt; Daisuke Kawauchi; Christel Herold-Mende; Felix Sahm; Sebastian Brandner; Marcel Kool; David T W Jones; Andreas von Deimling; Stefan M Pfister; David E Reuss; Kristian W Pajtler Journal: Acta Neuropathol Date: 2019-08-14 Impact factor: 17.088
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