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Pediatric spinal ependymomas: Long-term surgical outcomes in a cohort of 61 cases
Liang Zhang1, Xingyu Liu2, Bo Han2
1Department of Neurosurgery National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Insights
Pediatric spinal ependymomas require careful management. Gross-total resection offers the best prognosis, while recurrence is linked to Ki-67 index, subtype, and resection extent.
Area of Science:
- Pediatric neurosurgery
- Neuro-oncology
- Spinal cord tumors
Background:
- Spinal ependymomas are rare in children, with limited data on long-term outcomes and recurrence predictors.
- Understanding these factors is crucial for optimizing treatment strategies in this population.
Purpose of the Study:
- To analyze the clinic-radiological features, therapeutic approaches, and long-term outcomes of spinal ependymomas in pediatric patients.
- To identify independent predictors of tumor recurrence in this cohort.
Main Methods:
- Retrospective review of pediatric patients (≤18 years) who underwent surgical resection for spinal ependymomas (2012-2024).
- Progression-free survival (PFS) analyzed using Kaplan-Meier methods.
- Cox proportional hazards model used to identify recurrence predictors.
Main Results:
- 61 children were included; WHO grade 2 ependymoma (EPN) was most common (59.0%).
- Gross-total resection (GTR) achieved in 62.3%; 31.1% experienced recurrence.
- 5- and 10-year PFS rates were 73.4% and 59.6%. GTR, myxopapillary ependymoma (MPE) subtype, and Ki-67 ≥8% predicted recurrence.
Conclusions:
- Gross-total resection (GTR) is the optimal treatment for pediatric spinal ependymomas, associated with favorable prognosis.
- Tumor recurrence is influenced by the extent of resection, histological subtype (MPE), and Ki-67 proliferation index.
Importance:
Spinal ependymomas are rare in the pediatric population, with limited evidence of long-term outcomes and predictors of recurrence.
Objective:
To analyze clinic-radiological features, therapeutic methods, and long-term outcomes in a pediatric cohort.
Methods:
We retrospectively reviewed patients ≤18 years who underwent surgical resection for spinal ependymomas between January 2012 and July 2024. Progression-free survival (PFS) was estimated using Kaplan-Meier analysis, and predictors of recurrence were analyzed using the Cox proportional hazards method.
Results:
Among 61 children (age 13.7 ± 3.7 years), spinal ependymoma (EPN) (WHO grade 2) was the most common subtype (n = 36, 59.0%), followed by myxopapillary ependymoma (MPE) (n = 13, 21.3%), EPN (WHO grade 3) (n = 11, 18.1%) and subependymoma (SE) (n = 1, 1.6%). Gross-total resection (GTR) was achieved in 38 patients (62.3%). Over a follow-up of 42.8 ± 34.9 months, 19 patients (31.1%) experienced tumor recurrence. Functional improvement was observed in 38 children (62.3%). The 5- and 10-year progression-free survival (PFS) rates were 73.4% and 59.6%, respectively. In grade 2 EPN, subtotal resection (STR) followed by radiotherapy yielded significantly better 5- and 10-year PFS than STR alone (100% vs. 42.9%; 66.7% vs. 21.4%, respectively). Multivariable analysis identified extent of resection (P = 0.015), MPE subtype (P = 0.014), and Ki-67 ≥8% (P = 0.001) as independent predictors of recurrence.
Interpretation:
GTR remains the best treatment modality for pediatric patients with spinal ependymomas and has a favorable prognosis. Tumor recurrence is common and is related to the Ki-67 index, histological subtype, and the extent of resection.
