Adult ependymal tumors: prognosis and the M. D. Anderson Cancer Center experience.
Ependymomas in adults are rare and often misdiagnosed. This study reports on a series of adult patients with confirmed ependymoma treated at The University of Texas M. D. Anderson Cancer Center (MDACC). Patients aged >17 and with ependymoma were identified, and clinical data were collected by retrospective chart review. Descriptive statistics were used to describe the clinical data, Kaplan-Meier methods were used to generate survival curves, and Cox proportional hazards models were used to evaluate the association of clinical characteristics with survival. This series included 123 adult patients [51% male; median age 39 years (18-72)]. Forty had tumors in the brain, 80 in the spine, and 3 had both. The majority were Grade I/II lesions (108) vs Grade III (anaplastic; 15). Eighteen patients had tumors that were reclassified as ependymal tumors at MDACC. The most common presenting symptom was pain, with an average of 4 symptoms reported prior to diagnosis. Sixty-three percent of patients had a gross total resection, and 49% received radiation therapy. Average follow-up was 5.5 years, and 13% had died. Median time to recurrence was 21 months (Grade II) brain and 18 months (Grade III). Worse outcome measured by overall and progression-free survival were associated with brain location (P = .01, P = .04) and tumor anaplasia (P = .0025, P = .001). An MIB-1 > 10 was associated with worse outcome (P = .03). Tumor grade and brain location are associated with a worse prognosis. Reclassification of ependymoma by neuropathologists is common. Results of this study have lead to a multicenter study to further define important diagnostic and prognostic variables for adults with ependymoma.
Department of Integrative Nursing Care, Room 791, 6901 Bertner Ave., Houston, TX 77030, USA. terri.s.armstrong@uth.tmc.edu
Terri S
TS
Armstrong
Elizabeth
E
Vera-Bolanos
B Nebiyou
BN
Bekele
Kenneth
K
Aldape
Mark R
MR
Gilbert
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D004806:Ependymoma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D019394:Ki-67 Antigen / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011379:Prognosis; D016016:Proportional Hazards Models; D011878:Radiotherapy; D012189:Retrospective Studies; D055815:Young Adult
D000970:Antineoplastic Agents; D019394:Ki-67 Antigen