title: Outcome predictors in the management of spinal myxopapillary ependymoma: an integrative survival analysis.
abstract: OBJECTIVE
  The results in earlier studies have described a variable association with age, extent of resection, and radiotherapy (RT) correlating with the survival of myxopapillary ependymomas. The aim of our study is to perform a survival analysis on patient data gathered from a comprehensive review of the literature and determine the influence of these factors on progression-free (PFS) and overall survival (OS).
  
  
  METHODS
  A PubMed search was performed to select the articles containing information about the critical events (recurrence/death), time to events, and treatment characteristics (extent of resection with or without RT) in the patients with spinal myxopapillary ependymomas.
  
  
  RESULTS
  A total of 337 patients with information regarding the critical events, time to events, and treatment characteristics was selected for the inclusion. Patients in gross-total resection group had better PFS and OS (P = 0.001, P = 0.000 respectively). The patients in older age group (>35 years) had better PFS (P = 0.008). Overall PFS did not improve if RT was combined with surgery compared with surgery alone; however, the adjuvant RT benefitted the patients age ≤35 years. RT dose >50 Gy had significant influence on the PFS (P = 0.034).
  
  
  CONCLUSIONS
  Gross-total resection plays the most important role in improving PFS and OS. Older patients had better PFS; however, the influence of adjuvant RT was significant in younger age groups. A dose of >50 Gy improves the results, but a randomized controlled study is warranted to arrive at a definite conclusion.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kukreja
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana, USA.
authors.forename: Sudheer
authors.initials: S
authors.lastname: Ambekar
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana, USA.
authors.forename: Mayur
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana, USA.
authors.forename: Anthony Hunkyun
authors.initials: AH
authors.lastname: Sin
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana, USA. Electronic address: ananda@lsuhsc.edu.
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
mesh_terms: D000367:Age Factors; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004806:Ependymoma / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D013120:Spinal Cord Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Integrative analysis; Myxopapillary spendymoma; Spine; Survival