Brain Tumor Res Treat.  2017 Oct;5(2):70-76. 10.14791/btrt.2017.5.2.70.

Ependymomas: Prognostic Factors and Outcome Analysis in a Retrospective Series of 33 Patients

• Chai YH
• Jung S
• Lee JK
• Kim IY
• Jang WY
• Moon KS
• Kim JH
• Lee KH
• Kim SK
• Jung TY

• KMID: 2396450
• DOI: http://doi.org/10.14791/btrt.2017.5.2.70

Abstract

BACKGROUND
The purpose of this study was to evaluate the prognostic factors and outcomes in patients with ependymoma to management plans.
METHODS
Between 1997 and 2013, 33 patients with 25 ependymomas (WHO grade II) and eight anaplastic ependymomas (WHO grade III) were pathologically diagnosed. Six were pediatric patients (mean age, 6.15 years; range, 1.3-11 years), while 27 were adults (mean age, 47.5 years; range, 19-70 years). Of those, there were 12 adult patients with totally resected ependymomas without anaplastic pathology and adjuvant treatment. Prognostic factors were assessed in ependymoma patients. Prognostic factors were studied using Kaplan-Meier estimates in subgroups.
RESULTS
For six pediatric patients, the progression-free survival (PFS) was 43.7±13.5 months, and the overall survival (OS) was 58.1±13.7 months. For 27 adult patients, the PFS was 125.6±14.3 months, and the OS was 151.2±12.5 months. Age demonstrated a statistically significant effect on PFS (p=0.03) and OS (p=0.03). In adult ependymomas, the extent of tumor removal significantly affected PFS (p=0.03) and trended towards an effect on OS (p=0.06). Out of 12 patients with totally resected ependymomas without anaplastic pathology and adjuvant treatment, one patient showed tumor recurrence during follow-up (mean, 93.5 months; range, 27.9-162.7 months).
CONCLUSION
Adult patients with ependymomas were found to have better survival rates compared to pediatric patients. We suggest that totally resected adult ependymomas without anaplastic pathology could be observed without any adjuvant treatment, regardless of the tumor location.

Keyword

Ependymoma; Surgery; Prognosis; Radiotherapy

MeSH Terms

Adult
Disease-Free Survival
Ependymoma*
Follow-Up Studies
Humans
Pathology
Prognosis
Radiotherapy
Recurrence
Retrospective Studies*
Survival Rate

Figure

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  Fig. 1 Kaplan-Meier curves for PFS and OS. A: OS depends on age in all patients. The three-year OS rate was 80.9% for adults, and 66.7% for pediatric patients (p=0.03). B: PFS depends on age and tumor location in all patients. Pediatric-infratentorial group showed the trend of poor prognosis compared to adult-spinal cord group in terms of PFS. The three-year PFS rate was 40.0% for pediatric-infratentorial group, and 100% for adult-spinal cord group (p=0.03). C: PFS with extent of removal in adult patients. The one-year PFS rate was 100% for GTR, and 75% for STR (p=0.04). PFS, progression-free survival; OS, overall survival; GTR, gross total resection; STR, subtotal resection.

• 

  Fig. 2 One case of recurrence out of 12 adult patients with totally resected ependymomas without anaplastic pathology or postoperative adjuvant treatment. A: A 3.7-cm-sized ependymoma in the fourth ventricle (white arrowhead). B: No remnants of the lesion after total resection. C: On first year after surgery, a 1-cm-sized recurrent lesion (white arrowhead). D: No recurrence over the course of 92 months of follow-up.

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