Pathology of spinal ependymomas: an institutional experience over 25 years in 134 patients Journal Article


Authors: Tarapore, P. E.; Modera, P.; Naujokas, A.; Oh, M. C.; Amin, B; Tihan, T.; Parsa, A. T.; Ames, C. P.; Chou, D.; Mummaneni, P. V.; Weinstein, P. R.
Article Title: Pathology of spinal ependymomas: an institutional experience over 25 years in 134 patients
Abstract: BACKGROUND: Ependymomas constitute approximately 40% of primary intraspinal tumors. Current World Health Organization (WHO) grading may not correlate with observed progression-free survival (PFS). OBJECTIVE: This retrospective study of prospectively collected data examines whether PFS is influenced by the histological grade or by the extent of resection. It also analyzes the usage and effectiveness of postoperative adjuvant radiotherapy. METHODS: We reviewed 134 consecutive patients with ependymomas of all grades. Pathology slides were re-reviewed and the histological grades were confirmed by a single neuropathologist. Postoperative residual or recurrence was evaluated with follow-up magnetic resonance imaging. RESULTS: There were 85 male and 49 female patients, ranging from 10 to 79 (median 41) years of age. Thirty patients had WHO grade I tumors, 101 had grade II tumors, and 3 had grade III tumors. Kaplan-Meier analysis of PFS demonstrated a mean duration of 6 years for grade I, 14.9 years for grade II, and 3.7 years for grade III (P .001). In grade II ependymomas, mean PFS was 11.2 years with subtotal resection and 17.8 years with gross total resection (P .01). PFS of patients who underwent subtotal resection was not significantly changed by adjuvant radiotherapy (P .36). CONCLUSION: Patients with grade II ependymoma have significantly longer PFS than patients with grade I ependymoma. The extent of resection did not affect PFS in grade I ependymoma but it did in grade II. Contrary to its higher grade, WHO grade II ependymoma carries a better prognosis than WHO grade I ependymoma.
Keywords: Adult; Aged; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Young Adult; Male; Treatment Outcome; Retrospective Studies; Adolescent; Disease-Free Survival; Prognosis; Kaplan-Meier Estimate; Child; Radiotherapy, Adjuvant; Neurosurgical Procedures; Neoplasm Grading; Ependymoma/mortality/pathology/therapy; Neoplasm Recurrence, Local/epidemiology/pathology; Spinal Cord Neoplasms/mortality/pathology/therapy
Journal Title: Neurosurgery
Volume: 73
Issue: 2
ISSN: 1524-4040; 0148-396X
Publisher: Unknown  
Journal Place: United States
Date Published: 2013
Start Page: 247
End Page: 55; discussion 255
Language: eng
DOI/URL:
Notes: JID: 7802914; ppublish