title: Histologic grade and extent of resection are associated with survival in pediatric spinal cord ependymomas.
abstract: OBJECTIVE
  Prognostic factors affecting outcomes in pediatric spinal cord ependymomas are limited. We sought to investigate potential associations between extent of resection and histologic grade on progression-free survival (PFS) and overall survival (OS).
  
  
  METHODS
  A comprehensive literature search was performed to identify pediatric patients who underwent surgical resection for spinal cord ependymomas. Only manuscripts with clearly defined age, tumor grade, extent of resection, and clinical follow-up were included.
  
  
  RESULTS
  A total of 80 patients were identified with a histologic distribution as follows: 36 % myxopapillary (grade I), 54 % classical (grade II), and 10 % anaplastic (grade III). There was no association between tumor grade and PFS. The only factor associated with improved PFS was gross total resection (GTR), which remained significant in a multivariate model (hazard ratio (HR) = 0.248, p = 0.022). Moreover, older age (HR = 0.818, p = 0.026), GTR (HR = 0.042, p = 0.013), and anaplastic grade (HR = 19.847, p = 0.008) demonstrated a significant association with OS in a multivariate model.
  
  
  CONCLUSIONS
  Among pediatric patients with spinal cord ependymomas, PFS did not differ across histologic grades but was prolonged among patients who underwent GTR. Age, extent of resection, and tumor grade were all significantly associated with survival.
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94117, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Safaee
authors.forename: Michael C
authors.initials: MC
authors.lastname: Oh
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Kim
authors.forename: Derick
authors.initials: D
authors.lastname: Aranda
authors.forename: Phiroz E
authors.initials: PE
authors.lastname: Tarapore
authors.forename: Tene A
authors.initials: TA
authors.lastname: Cage
authors.forename: Nalin
authors.initials: N
authors.lastname: Gupta
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D018572:Disease-Free Survival; D004806:Ependymoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods*; D013120:Spinal Cord Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome