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Open Access 04-03-2024 | Ependymoma | Research

Clinical presentation and extent of resection impacts progression-free survival in spinal ependymomas

Authors: Mark A. Davison, Daniel T. Lilly, Arpan A. Patel, Ahmed Kashkoush, Xiaoying Chen, Wei Wei, Edward C. Benzel, Richard A. Prayson, Samuel Chao, Lilyana Angelov

Published in: Journal of Neuro-Oncology | Issue 3/2024

Abstract

Purpose

Primary treatment of spinal ependymomas involves surgical resection, however recurrence ranges between 50 and 70%. While the association of survival outcomes with lesion extent of resection (EOR) has been studied, existing analyses are limited by small samples and archaic data resulting in an inhomogeneous population. We investigated the relationship between EOR and survival outcomes, chiefly overall survival (OS) and progression-free survival (PFS), in a large contemporary cohort of spinal ependymoma patients.

Methods

Adult patients diagnosed with a spinal ependymoma from 2006 to 2021 were identified from an institutional registry. Patients undergoing primary surgical resection at our institution, ≥ 1 routine follow-up MRI, and pathologic diagnosis of ependymoma were included. Records were reviewed for demographic information, EOR, lesion characteristics, and pre-/post-operative neurologic symptoms. EOR was divided into 2 classifications: gross total resection (GTR) and subtotal resection (STR). Log-rank test was used to compare OS and PFS between patient groups.

Results

Sixty-nine patients satisfied inclusion criteria, with 79.7% benefitting from GTR. The population was 56.2% male with average age of 45.7 years, and median follow-up duration of 58 months. Cox multivariate model demonstrated significant improvement in PFS when a GTR was attained (p <.001). Independently ambulatory patients prior to surgery had superior PFS (p <.001) and OS (p =.05). In univariate analyses, patients with a syrinx had improved PFS (p =.03) and were more likely to benefit from GTR (p =.01). Alternatively, OS was not affected by EOR (p =.78).

Conclusions

In this large, contemporary series of adult spinal ependymoma patients, we demonstrated improvements in PFS when GTR was achieved.

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Title: Clinical presentation and extent of resection impacts progression-free survival in spinal ependymomas
Authors: Mark A. Davison
Daniel T. Lilly
Arpan A. Patel
Ahmed Kashkoush
Xiaoying Chen
Wei Wei
Edward C. Benzel
Richard A. Prayson
Samuel Chao
Lilyana Angelov
Publication date: 04-03-2024
Publisher: Springer US
Keywords: Ependymoma
Ependymoma
Ependymoma
Published in: Journal of Neuro-Oncology / Issue 3/2024
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-024-04623-4

At a glance: The STEP trials

Springer Medicine

Clinical presentation and extent of resection impacts progression-free survival in spinal ependymomas

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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Correction to: Preoperative patient-reported physical health-related quality of life predicts short-term postoperative outcomes in brain tumor patients