Multivariate analysis of clinical prognostic factors in children with intracranial ependymomas.
The optimal postoperative management of pediatric intracranial ependymomas is controversial. We analyzed clinical prognostic factors for their influence on outcome in such children. Our retrospective series included 15 with supratentorial and 28 with infratentorial tumors. Twenty ependymomas were grade II, and 23 were anaplastic. Complete resection was performed in 18 patients, incomplete resection in 19, and stereotactic biopsy in 6. Radiotherapy was done in 31 patients and chemotherapy in 13. The surviving patients have been followed 8-232 months (median: 69 months). The median survival time was 30 months, and 5-year overall survival and progression-free survival rates were 53.9% and 45.9%, respectively. By tumor site: supratentorial, 56.6% and 50.9%; infratentorial, 52.3% and 42.5%. Multivariate analysis identified complete resection (5-year progression-free survival, 71.8%) and age <3 years old as significant favorable and adverse prognostic features (relative risk, 2.59; 95% CI, 1.05-6.38), respectively. Twenty-six children relapsed 1-107 months after diagnosis (median: 12 months). Relapses were local in 22 cases, and combined local and distant in three cases. Only one of 15 patients with supratentorial tumors developed isolated spinal metastasis. Failure at the primary site is the major obstacle to improve cure rates. The extent of surgical resection and age were the only statistically significant prognostic factors.
Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan. jaing001@cgmh.org.tw
Tang-Her
TH
Jaing
Huei-Shyong
HS
Wang
Pei-Kwei
PK
Tsay
Chen-Kan
CK
Tseng
Shih-Ming
SM
Jung
Kuang-Lin
KL
Lin
Tai-Ngar
TN
Lui
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004806:Ependymoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D015192:Infratentorial Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D015173:Supratentorial Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis