title: Histological predictors of outcome in ependymoma are dependent on anatomic site within the central nervous system.
abstract: Ependymomas originate in posterior fossa (PF), supratentorial (ST) or spinal cord (SC) compartments. At present, grading schemes are applied independent of anatomic site. We performed detailed histological examination on 238 World Health Organization grade II and III ependymomas. Among PF ependymomas, the presence of hypercellular areas, necrosis, microvascular proliferation and elevated mitotic rate (all P < 0.01) were significantly associated with worse progression-free survival (PFS), while extensive ependymal canal formation was not (P = 0.89). Similar to the PF tumors, microvascular proliferation (P = 0.01) and elevated mitotic rate (P = 0.03) were significantly associated with worse PFS in the ST tumors. However, in contrast to PF tumors, extensive ependymal canals (P = 0.03) were associated with worse clinical outcome in ST ependymomas, but hypercellularity (P = 0.57) and necrosis (P = 0.47) were not. On multivariate Cox regression, after adjusting for relevant clinical variables, individual histological factors and a composite histological score remained significant among ST and PF ependymoma. In contrast to both PF and ST ependymoma, histological features were not found to be associated with PFS in SC tumors. Taken together, the clinical relevance of specific histological features in ependymoma appears to be related to the anatomic site of origin and suggests that site-specific grading criteria be considered in future classification systems.
authors: The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Aditya
authors: A
authors: Raghunathan
authors: Khalida
authors: K
authors: Wani
authors: Terri S
authors: TS
authors: Armstrong
authors: Elizabeth
authors: E
authors: Vera-Bolanos
authors: Maryam
authors: M
authors: Fouladi
authors: Richard
authors: R
authors: Gilbertson
authors: Amar
authors: A
authors: Gajjar
authors: Stewart
authors: S
authors: Goldman
authors: Norman L
authors: NL
authors: Lehman
authors: Phillipe
authors: P
authors: Metellus
authors: Tom
authors: T
authors: Mikkelsen
authors: Mary Jo T
authors: MJ
authors: Necesito-Reyes
authors: Antonio
authors: A
authors: Omuro
authors: Roger J
authors: RJ
authors: Packer
authors: Sonia
authors: S
authors: Partap
authors: Ian F
authors: IF
authors: Pollack
authors: Michael D
authors: MD
authors: Prados
authors: H Ian
authors: HI
authors: Robins
authors: Riccardo
authors: R
authors: Soffietti
authors: Jing
authors: J
authors: Wu
authors: C Ryan
authors: CR
authors: Miller
authors: Mark R
authors: MR
authors: Gilbert
authors: Kenneth D
authors: KD
authors: Aldape
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002490:Central Nervous System / Q000473:pathology*; D016543:Central Nervous System Neoplasms / Q000175:diagnosis* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004806:Ependymoma / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015996:Survival Rate; D055815:Young Adult
keywords: ependymoma; histology; progression-free survival