Histologic Grade and Extent of Resection Are Associated with Survival in Pediatric Spinal Cord Ependymomas

Overview

Journal Childs Nerv Syst

Specialty Pediatrics

Date 2013 May 17

PMID 23677177

Citations 11

Authors

Michael Safaee

Michael C Oh

Joseph M Kim

Derick Aranda

Phiroz E Tarapore

Tene A Cage

Nalin Gupta

Andrew T Parsa

Affiliations

Soon will be listed here.

Abstract

Purpose: Prognostic factors affecting outcomes in pediatric spinal cord ependymomas are limited. We sought to investigate potential associations between extent of resection and histologic grade on progression-free survival (PFS) and overall survival (OS).

Methods: A comprehensive literature search was performed to identify pediatric patients who underwent surgical resection for spinal cord ependymomas. Only manuscripts with clearly defined age, tumor grade, extent of resection, and clinical follow-up were included.

Results: A total of 80 patients were identified with a histologic distribution as follows: 36 % myxopapillary (grade I), 54 % classical (grade II), and 10 % anaplastic (grade III). There was no association between tumor grade and PFS. The only factor associated with improved PFS was gross total resection (GTR), which remained significant in a multivariate model (hazard ratio (HR) = 0.248, p = 0.022). Moreover, older age (HR = 0.818, p = 0.026), GTR (HR = 0.042, p = 0.013), and anaplastic grade (HR = 19.847, p = 0.008) demonstrated a significant association with OS in a multivariate model.

Conclusions: Among pediatric patients with spinal cord ependymomas, PFS did not differ across histologic grades but was prolonged among patients who underwent GTR. Age, extent of resection, and tumor grade were all significantly associated with survival.

Citing Articles

Intramedullary pediatric low-grade glioma of the spine.

Lu V, Jallo G, Shimony N Childs Nerv Syst. 2024; 40(10):3107-3117.

PMID: 38904769 DOI: 10.1007/s00381-024-06499-1.

Human Patient-Derived Brain Tumor Models to Recapitulate Ependymoma Tumor Vasculature.

Tang-Schomer M, Bookland M, Sargent J, N Jackvony T Bioengineering (Basel). 2023; 10(7).

PMID: 37508868 PMC: 10376907. DOI: 10.3390/bioengineering10070840.

Current management in the treatment of intramedullary ependymomas in children.

Entenmann C, Misove A, Holub M, Zapotocky M, Sumerauer D, Tomasek M Childs Nerv Syst. 2022; 39(5):1183-1192.

PMID: 36574011 DOI: 10.1007/s00381-022-05814-y.

Postoperative Cervicothoracic Kyphosis Following Infantile Intramedullary Tumor Resection Accelerates Neurological Deterioration.

Gonda T, Nagashima Y, Nishimura Y, Ito H, Nisii T, Oyama T NMC Case Rep J. 2022; 8(1):705-711.

PMID: 35079537 PMC: 8769416. DOI: 10.2176/nmccrj.cr.2021-0086.

Polish Multi-Institutional Study of Children with Ependymoma-Clinical Practice Outcomes in the Light of Prospective Trials.

Napieralska A, Mizia-Malarz A, Stolpa W, Pawlowska E, Krawczyk M, Konat-Baska K Diagnostics (Basel). 2021; 11(12).

PMID: 34943596 PMC: 8700631. DOI: 10.3390/diagnostics11122360.

References

Mork S, Risberg G, Krogness K . Case report. Anaplastic ependymoma of the spinal cord. Neuropathol Appl Neurobiol. 1980; 6(4):307-11. DOI: 10.1111/j.1365-2990.1980.tb00215.x. View

Horn B, Heideman R, Geyer R, Pollack I, Packer R, Goldwein J . A multi-institutional retrospective study of intracranial ependymoma in children: identification of risk factors. J Pediatr Hematol Oncol. 1999; 21(3):203-11. DOI: 10.1097/00043426-199905000-00008. View

Preston-Martin S . Descriptive epidemiology of primary tumors of the spinal cord and spinal meninges in Los Angeles County, 1972-1985. Neuroepidemiology. 1990; 9(2):106-11. DOI: 10.1159/000110757. View

Armstrong T, Vera-Bolanos E, Bekele B, Aldape K, Gilbert M . Adult ependymal tumors: prognosis and the M. D. Anderson Cancer Center experience. Neuro Oncol. 2010; 12(8):862-70. PMC: 2940672. DOI: 10.1093/neuonc/noq009. View

Modena P, Lualdi E, Facchinetti F, Veltman J, Reid J, Minardi S . Identification of tumor-specific molecular signatures in intracranial ependymoma and association with clinical characteristics. J Clin Oncol. 2006; 24(33):5223-33. DOI: 10.1200/JCO.2006.06.3701. View

Schiffer D, Chio A, Giordana M, Migheli A, Palma L, Pollo B . Histologic prognostic factors in ependymoma. Childs Nerv Syst. 1991; 7(4):177-82. DOI: 10.1007/BF00249392. View

McLaughlin M, Marcus Jr R, Buatti J, McCollough W, Mickle J, Kedar A . Ependymoma: results, prognostic factors and treatment recommendations. Int J Radiat Oncol Biol Phys. 1998; 40(4):845-50. DOI: 10.1016/s0360-3016(97)00893-6. View

Mridha A, Sharma M, Sarkar C, Suri V, Rishi A, Garg A . Myxopapillary ependymoma of lumbosacral region with metastasis to both cerebellopontine angles: report of a rare case. Childs Nerv Syst. 2007; 23(10):1209-13. DOI: 10.1007/s00381-007-0423-5. View

Lin Y, Huang C, Wong T, Chen M, Shiau C, Wang L . Treatment of spinal cord ependymomas by surgery with or without postoperative radiotherapy. J Neurooncol. 2005; 71(2):205-10. DOI: 10.1007/s11060-004-1386-y. View

10.

Cho J, Miller A, Kettner N . Cervical ependymoma in a male adolescent with neck and back pain. J Manipulative Physiol Ther. 2009; 32(8):695-700. DOI: 10.1016/j.jmpt.2009.08.021. View

11.

Morris D, Steinert H, Wiernik P . Ineffectiveness of chemotherapy in patients with metastatic ependymoma of the cauda equina. J Surg Oncol. 1983; 22(1):33-6. DOI: 10.1002/jso.2930220109. View

12.

Schellinger K, Propp J, Villano J, McCarthy B . Descriptive epidemiology of primary spinal cord tumors. J Neurooncol. 2007; 87(2):173-9. DOI: 10.1007/s11060-007-9507-z. View

13.

Engelhard H, Villano J, Porter K, Stewart A, Barua M, Barker F . Clinical presentation, histology, and treatment in 430 patients with primary tumors of the spinal cord, spinal meninges, or cauda equina. J Neurosurg Spine. 2010; 13(1):67-77. DOI: 10.3171/2010.3.SPINE09430. View

14.

Di Marco A, Griso C, Pradella R, Campostrini F, GARUSI G . Postoperative management of primary spinal cord ependymomas. Acta Oncol. 1988; 27(4):371-5. DOI: 10.3109/02841868809093557. View

15.

Bagley C, Kothbauer K, Wilson S, Bookland M, Epstein F, Jallo G . Resection of myxopapillary ependymomas in children. J Neurosurg. 2007; 106(4 Suppl):261-7. DOI: 10.3171/ped.2007.106.4.261. View

16.

Al-Halabi H, Montes J, Atkinson J, Farmer J, Freeman C . Adjuvant radiotherapy in the treatment of pediatric myxopapillary ependymomas. Pediatr Blood Cancer. 2010; 55(4):639-43. DOI: 10.1002/pbc.22614. View

17.

Nishio S, Morioka T, Fujii K, Inamura T, Fukui M . Spinal cord gliomas: management and outcome with reference to adjuvant therapy. J Clin Neurosci. 2000; 7(1):20-3. DOI: 10.1054/jocn.1999.0128. View

18.

Benesch M, Weber-Mzell D, Gerber N, von Hoff K, Deinlein F, Krauss J . Ependymoma of the spinal cord in children and adolescents: a retrospective series from the HIT database. J Neurosurg Pediatr. 2010; 6(2):137-44. DOI: 10.3171/2010.5.PEDS09553. View

19.

Taylor M, Poppleton H, Fuller C, Su X, Liu Y, Jensen P . Radial glia cells are candidate stem cells of ependymoma. Cancer Cell. 2005; 8(4):323-35. DOI: 10.1016/j.ccr.2005.09.001. View

20.

Wen B, Hussey D, Hitchon P, Schelper R, Vigliotti A, Doornbos J . The role of radiation therapy in the management of ependymomas of the spinal cord. Int J Radiat Oncol Biol Phys. 1991; 20(4):781-6. DOI: 10.1016/0360-3016(91)90023-w. View