title: Prognosis by tumor location for pediatric spinal cord ependymomas.
abstract: OBJECTIVE
  Ependymoma is a common CNS tumor in children, with spinal cord ependymomas making up 13.1% of all ependymomas in this age group. The clinical features that affect prognosis in pediatric spinal cord ependymomas are not well understood. A comprehensive literature review was performed to determine whether a tumor location along the spinal cord is prognostically significant in children undergoing surgery for spinal cord ependymomas.
  
  
  METHODS
  A PubMed search was performed to identify all papers that contained data on patients with spinal cord ependymomas. Only pediatric patients (age < 18 years) who underwent resection with a clearly reported tumor location were included in the analysis. Myxopapillary tumors were excluded from study. Tumor location was subdivided into 6 regions: cervicomedullary, cervical, cervicothoracic, thoracic, thoracolumbar, and conus medullaris. Kaplan-Meier survival and Cox regression analyses were performed to determine the effects of tumor location on progression-free survival (PFS) and overall survival (OS).
  
  
  RESULTS
  Fifty-eight patients who underwent resection of spinal cord ependymomas were identified. Ependymomas were located all along the spinal cord but occurred with the highest frequency in the cervical region (29.3%). Progression-free survival was significantly better in patients with tumors arising in the upper portion of the spinal cord (p = 0.031), which remained significant in the multivariate Cox regression analysis (p < 0.05). Moreover, OS was significantly better in patients with upper spinal cord ependymomas than in those harboring ependymomas in the lower spinal cord (p = 0.048).
  
  
  CONCLUSIONS
  Although more common in adults, spinal ependymomas can occur anywhere along the spinal cord in the pediatric population; however, tumors occurring in the lower half of the spinal cord carry a worse prognosis with shorter PFS and OS. By comparison, ependymomas in the upper spinal cord recur later and less frequently, with little or no mortality in this patient group.
authors.affiliation: Departments of Neurological Surgery, University of California, San Francisco, CA 94117, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Oh
authors.forename: Eli T
authors.initials: ET
authors.lastname: Sayegh
authors.forename: Michael
authors.initials: M
authors.lastname: Safaee
authors.forename: Matthew Z
authors.initials: MZ
authors.lastname: Sun
authors.forename: Gurvinder
authors.initials: G
authors.lastname: Kaur
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Kim
authors.forename: Derick
authors.initials: D
authors.lastname: Aranda
authors.forename: Annette M
authors.initials: AM
authors.lastname: Molinaro
authors.forename: Nalin
authors.initials: N
authors.lastname: Gupta
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004806:Ependymoma / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D019635:Neurosurgical Procedures; D011379:Prognosis; D016016:Proportional Hazards Models; D013120:Spinal Cord Neoplasms / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome