Prognosis by tumor location for pediatric spinal cord ependymomas
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Published on: December 27, 2024
Michael C Oh1, Eli T Sayegh, Michael Safaee
1Departments of Neurological Surgery, University of California, San Francisco, CA 94117, USA.
Insights
Pediatric spinal cord ependymomas in the lower spinal cord are linked to worse outcomes. Tumors in the upper spinal cord show better progression-free survival (PFS) and overall survival (OS).
Area of Science:
- Pediatric neuro-oncology
- Neurosurgery
- Clinical oncology
Background:
- Spinal cord ependymomas are common central nervous system (CNS) tumors in children.
- Prognostic factors for pediatric spinal cord ependymomas are not fully understood.
- Tumor location is a potential prognostic indicator.
Purpose of the Study:
- To investigate the prognostic significance of tumor location in pediatric spinal cord ependymomas.
- To determine if location influences progression-free survival (PFS) and overall survival (OS) after surgery.
Main Methods:
- Comprehensive literature review of PubMed-indexed studies.
- Inclusion of pediatric patients (<18 years) with resected spinal cord ependymomas and reported tumor location.
- Exclusion of myxopapillary ependymomas.
- Categorization of tumor location into 6 spinal regions.
- Statistical analysis using Kaplan-Meier survival and Cox regression.
Main Results:
- Fifty-eight pediatric spinal cord ependymomas were analyzed.
- Cervical region showed the highest tumor frequency (29.3%).
- Upper spinal cord tumors had significantly better PFS (p=0.031) and OS (p=0.048) compared to lower spinal cord tumors.
Conclusions:
- Tumor location in the pediatric spinal cord significantly impacts prognosis.
- Lower spinal cord ependymomas are associated with worse PFS and OS.
- Upper spinal cord ependymomas demonstrate a more favorable prognosis with later recurrence and lower mortality.
Object:
Ependymoma is a common CNS tumor in children, with spinal cord ependymomas making up 13.1% of all ependymomas in this age group. The clinical features that affect prognosis in pediatric spinal cord ependymomas are not well understood. A comprehensive literature review was performed to determine whether a tumor location along the spinal cord is prognostically significant in children undergoing surgery for spinal cord ependymomas.
Methods:
A PubMed search was performed to identify all papers that contained data on patients with spinal cord ependymomas. Only pediatric patients (age < 18 years) who underwent resection with a clearly reported tumor location were included in the analysis. Myxopapillary tumors were excluded from study. Tumor location was subdivided into 6 regions: cervicomedullary, cervical, cervicothoracic, thoracic, thoracolumbar, and conus medullaris. Kaplan-Meier survival and Cox regression analyses were performed to determine the effects of tumor location on progression-free survival (PFS) and overall survival (OS).
Results:
Fifty-eight patients who underwent resection of spinal cord ependymomas were identified. Ependymomas were located all along the spinal cord but occurred with the highest frequency in the cervical region (29.3%). Progression-free survival was significantly better in patients with tumors arising in the upper portion of the spinal cord (p = 0.031), which remained significant in the multivariate Cox regression analysis (p < 0.05). Moreover, OS was significantly better in patients with upper spinal cord ependymomas than in those harboring ependymomas in the lower spinal cord (p = 0.048).
Conclusions:
Although more common in adults, spinal ependymomas can occur anywhere along the spinal cord in the pediatric population; however, tumors occurring in the lower half of the spinal cord carry a worse prognosis with shorter PFS and OS. By comparison, ependymomas in the upper spinal cord recur later and less frequently, with little or no mortality in this patient group.
