title: Pediatric infratentorial ependymoma: prognostic significance of anaplastic histology.
abstract: Pediatric infratentorial ependymomas are difficult to cure. Despite the availability of advanced therapeutic modalities for brain tumors, total surgical resection remains the most important prognostic factor. Recently, histological grade emerged as an independent prognostic factor for intracranial ependymoma. We retrospectively reviewed the treatment outcome of 33 pediatric patients with infratentorial ependymoma. Progression-free survival (PFS) and overall survival (OS) rates were calculated and relevant prognostic factors were analyzed. Fourteen patients (42%) were under the age of 3 at diagnosis. Gross total resection was achieved in 16 patients (49%). Anaplastic histology was found in 13 patients (39%). Adjuvant therapies were delayed until progression in 12 patients (36%). Actuarial PFS rates were 64% in the first year and 29% in the fifth year. Actuarial OS rates were 91% in the first year and 71% in the fifth year. On univariate analysis, brainstem invasion (P = 0.047), anaplastic histology (P = 0.004), higher mitotic count (P = 0.001), and higher Ki-67 index (P = 0.004) were significantly related to a shorter PFS. Gross total resection (P = 0.029) and a greater age at diagnosis (P = 0.033) were significantly related to a longer PFS. On multivariate analysis, anaplastic histology alone was significantly related to a shorter PFS (P = 0.023). Gross total resection (P = 0.039) was significantly related to a longer overall survival (OS) on multivariate analysis. Anaplastic histology and gross total resection were the most important clinical factors affecting PFS and OS, respectively. Anaplastic histology, mitotic count, and Ki-67 index can be used as universal and easily available prognostic parameters in infratentorial ependymomas.
authors.affiliation: Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Phi
authors.forename: Kyu-Chang
authors.initials: KC
authors.lastname: Wang
authors.forename: Sung-Hye
authors.initials: SH
authors.lastname: Park
authors.forename: Il Han
authors.initials: IH
authors.lastname: Kim
authors.forename: In-One
authors.initials: IO
authors.lastname: Kim
authors.forename: Kyung Duk
authors.initials: KD
authors.lastname: Park
authors.forename: Hyo Seop
authors.initials: HS
authors.lastname: Ahn
authors.forename: Ji Yeoun
authors.initials: JY
authors.lastname: Lee
authors.forename: Young-Je
authors.initials: YJ
authors.lastname: Son
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Kim
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D057286:Electronic Health Records / Q000706:statistics & numerical data; D004806:Ependymoma / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015192:Infratentorial Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D019394:Ki-67 Antigen