An integrative analysis of treatment, outcomes and prognostic factors for primary spinal anaplastic ependymomas

Chen, Peiqin; Sui, Mingxing; Ye, Jingliang; Wan, Zhiping; Chen, Feng; Luo, Chun

doi:10.1016/j.jocn.2014.11.032

Cited by 13 publications

(11 citation statements)

References 25 publications

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“…On the contrary, adjuvant RT does not influence progression-free survival (PFS). In contrast, the study by Chen et al [ 13 ] suggested that adjuvant radiotherapies are considerable prognostic indicators in primary spinal anaplastic ependymomas, and age in this study was not significantly associated with the result. Various studies have attempted to clarify the prognostic factors of ependymomas, [ 12 – 15 ] but few have focused on CEs individually.…”

Section: Introductioncontrasting

confidence: 99%

Outcome predictors in the management of intramedullary classic ependymoma

et al. 2018

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This is a retrospective study.The aim of this study was to illustrate the survival outcomes of patients with classic ependymoma (CE) and identify potential prognostic factors.CE is the most common category of spinal ependymomas, but few published studies have discussed predictors of the survival outcome.A Boolean search of the PubMed, Embase, and OVID databases was conducted by 2 investigators independently. The objects were intramedullary grade II ependymoma according to 2007 WHO classification. Univariate Kaplan–Meier analysis and Log-Rank tests were performed to identify variables associated with progression-free survival (PFS) or overall survival (OS). Multivariate Cox regression was performed to assess hazard ratios (HRs) with 95% confidence intervals (95% CIs). Statistical analysis was performed by SPSS version 23.0 (IBM Corp.) with statistical significance defined as P < .05.A total of 35 studies were identified, including 169 cases of CE. The mean follow-up time across cases was 64.2 ± 51.5 months. Univariate analysis showed that patients who had undergone total resection (TR) had better PFS and OS than those with subtotal resection (STR) and biopsy (P = .002, P = .004, respectively). Within either univariate or multivariate analysis (P = .000, P = .07, respectively), histological type was an independent prognostic factor for PFS of CE [papillary type: HR 0.002, 95% CI (0.000–0.073), P = .001, tanycytic type: HR 0.010, 95% CI (0.000–0.218), P = .003].It was the first integrative analysis of CE to elucidate the correlation between kinds of factors and prognostic outcomes. Definite histological type and safely TR were foundation of CE's management.Level of Evidence: 4

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Section: Introductioncontrasting

confidence: 99%

Outcome predictors in the management of intramedullary classic ependymoma

et al. 2018

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“…These results are consistent with previous systematic reviews. 51 -53 Our analysis showed that postoperative adjuvant radiotherapy did not affect surgical outcomes. This result is consistent with a study conducted by Feldman et al, which reported no association between radiotherapy and overall tumor recurrence, regardless of the extent of resection.…”

Section: Discussionmentioning

confidence: 74%

“… 52 Wang et al 54 also showed that adjuvant therapy could not improve outcomes after resection. However, Chen et al 51 reported that adjuvant radiotherapy positively affected PFS. This discrepancy could be due to the population of this study which only included high-grade ependymomas.…”

Section: Discussionmentioning

confidence: 99%

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Complete Versus Incomplete Surgical Resection in Intramedullary Ependymomas: A Systematic Review and Meta-analysis

Salari

Golpayegani

Sadeghi‐Naini

et al. 2020

Global Spine Journal

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Study Design: Systematic review. Objective: To compare outcomes of complete versus incomplete resection in primary intramedullary spinal cord ependymoma. Methods: A comprehensive search of the MEDLINE, CENTRAL, and Embase databases was conducted by 2 independent investigators. Random-effect meta-analysis and meta-regression with seven covariates were performed to evaluate the reason for the heterogeneity among studies. We also used individual patient data in the integrative analysis to compare complete and incomplete resection based on 4 outcomes: progression-free survival (PFS), overall survival (OS), postoperative neurological improvement (PNI), and follow-up neurological improvement (FNI). Results: A total of 23 studies were identified, including 407 cases. Significant heterogeneity among included studies was observed in risk estimates (I2 for PFS, FNI, and PNI were 49.5%, 78.3%, and 87.2%, respectively). The mean follow-up time across cases was 48.6 ± 2.35 months. Cox proportional multivariable analysis revealed that the complete resection can prolong PFS (model, hazard ratio = 0.18, CI 0.05-0.54, P = .004,) and improve the FNI (binary logistic regression, adjusted odds ratio = 16.5, CI 1.6-171, P = .019). However, PNI and OS were similar in patients with incomplete resected spinal cord ependymoma compared with complete resection (binary logistic regression respectively and Cox multivariable analysis, P > .5). Conclusion: The data presented in this study showed that OS was not significantly affected by the degree of surgery. However, complete resection of intramedullary ependymomas provides the optimal outcomes with longer PFS and better long-term neurological outcomes than incomplete resection.

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“…In the early postoperative course, 9–67% of patients may experience a deterioration in their neurological status. 14–16 The need for tracheotomy was reported in 10.7–28.9% of cases, and the need for a nasogastric tube was reported in 21.4%. 2 , 4 These manipulations were temporary in all cases.…”

Section: Discussionmentioning

confidence: 99%

Treatment strategy for multisegmental cervicomedullary ependymoma: illustrative case

Zrelov¹,

Tastanbekov²,

Alexandrov³

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Сervicomedullary ependymoma (CME) is a rare tumor of the central nervous system. The CME treatment strategy is insufficiently represented in the literature and is a complex task for neurosurgeons. OBSERVATIONS The authors describe an infrequent case of a large multisegmental CME that extended from the medulla oblongata to the cervical spinal cord at the level of the sixth cervical vertebra in a 21-year-old female. Neurological disorders presented with headache, dysphagia, hypophonia, and weakness in the limbs. Subtotal removal of the tumor was performed according to intraoperative neurophysiological monitoring (IONM) results. A wait-and-see approach with patient follow-up was chosen. LESSONS Total tumor removal of the CME is the most important favorable prognostic factor. Subtotal resection can be considered if the borders of the tumor are unclear and the result of IONM is unfavorable. The role of postoperative radiation therapy in the case of subtotal removal of the tumor remains controversial.

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An integrative analysis of treatment, outcomes and prognostic factors for primary spinal anaplastic ependymomas

Cited by 13 publications

References 25 publications

Outcome predictors in the management of intramedullary classic ependymoma

Outcome predictors in the management of intramedullary classic ependymoma

Complete Versus Incomplete Surgical Resection in Intramedullary Ependymomas: A Systematic Review and Meta-analysis

Treatment strategy for multisegmental cervicomedullary ependymoma: illustrative case

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