Outcome predictors in the management of intramedullary classic ependymoma

Abstract

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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“…Ependymoma is originated from the ependymal lining of the ventricular system or spinal canal, which may arise from anywhere along the ventricular system and spinal cord [2]. The World Health Organization (WHO) has classified ependymomas into 3 grades: Grade I; myxopapillary ependymoma and sub-ependymoma, Grade II; ependymoma and Grade III anaplastic ependymomas [3]. Although there is a long history of subclassifying ependymoma in histology, there is little treatment stratification for ependymomas and the long-term prognosis for patients with ependymoma remains barely understood [4].…”

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

“…This is inconsistent with the systematic review by Wang et al 54 The multivariate Cox model used to evaluate prognostic factors in spinal cord ependymomas showed that the extent of surgery did not increase OS (HR = 0.690, 95% CI = 0.119-3.977, P = .679). Wang et al 54 conducted an integrative analysis on grade II ependymomas and found that the extent of surgery did not have a statistical effect on OS. However, most previous reviews claimed that CR is associated with better 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. 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.…”

Do We Need Radiotherapy in Grade II Ependymoma?

“…Because recurrences can occur many years after the treatment, regardless of the EOR, long-term follow-up with MR is recommended. Older age, male sex, other than classical G2 pathological types (cellular, papillary, giant cell types) were found as negatively influencing the outcome (8,32,37,39,41).…”