title: Supratentorial hemispheric ependymomas: an analysis of 109 adults for survival and prognostic factors.
abstract: OBJECTIVE Survival rates and prognostic factors for supratentorial hemispheric ependymomas have not been determined. The authors therefore designed a retrospective study to determine progression-free survival (PFS), overall survival (OS), and prognostic factors for hemispheric ependymomas. METHODS The study population consisted of 8 patients from our institution and 101 patients from the literature with disaggregated survival information (n = 109). Patient age, sex, tumor side, tumor location, extent of resection (EOR), tumor grade, postoperative chemotherapy, radiation, time to recurrence, and survival were recorded. Kaplan-Meier survival analyses and Cox proportional hazard models were completed to determine survival rates and prognostic factors. RESULTS Anaplastic histology/WHO Grade III tumors were identified in 62% of cases and correlated with older age. Three-, 5-, and 10-year PFS rates were 57%, 51%, and 42%, respectively. Three-, 5-, and 10-year OS rates were 77%, 71%, and 58%, respectively. EOR and tumor grade were identified on both Kaplan-Meier log-rank testing and univariate Cox proportional hazard models as prognostic for PFS and OS. Both EOR and tumor grade remained prognostic on multivariate analysis. Subtotal resection (STR) predicted a worse PFS (hazard ratio [HR] 4.764, p = 0.001) and OS (HR 4.216, p = 0.008). Subgroup survival analysis of patients with STR demonstrated a 5- and 10-year OS of 28% and 0%, respectively. WHO Grade III tumors also had worse PFS (HR 10.2, p = 0.004) and OS (HR 9.1, p = 0.035). Patients with WHO Grade III tumors demonstrated 5- and 10-year OS of 61% and 46%, respectively. Postoperative radiation was not prognostic for PFS or OS. CONCLUSIONS A high incidence of anaplastic histology was found in hemispheric ependymomas and was associated with older age. EOR and tumor grade were prognostic factors for PFS and OS on multivariate analysis. STR or WHO Grade III pathology, or both, predicted worse overall prognosis in patients with hemispheric ependymoma.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Todd
authors.initials: T
authors.lastname: Hollon
authors.affiliation: Temple University Medical School, Philadelphia, Pennsylvania.
authors.forename: Vincent
authors.initials: V
authors.lastname: Nguyen
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Brandon W
authors.initials: BW
authors.lastname: Smith
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Spencer
authors.initials: S
authors.lastname: Lewis
authors.affiliation: Neurology, University of Michigan, Ann Arbor, Michigan; and.
authors.forename: Larry
authors.initials: L
authors.lastname: Junck
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Orringer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D004806:Ependymoma / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D055815:Young Adult
keywords: EOR = extent of resection; GTR = gross total resection; OS = overall survival; PFS = progression-free survival; STR = subtotal resection; brain tumor; ependymoma; glioma; oncology; prognosis; survival