Geriatric Patients Undergo Surgery Less Often and Have Worse Survival Outcomes Compared to Pediatric and Adult Cohorts with Intramedullary Ependymoma: A SEER Analysis
Resident University of Rochester Medical Center Rochester, NY, US
Disclosure(s):
Taylor Furst, MD: No financial relationships to disclose
Introduction: Intramedullary ependymomas account for ~50% of all primary intramedullary tumors. Though gross total resection has become mainstay, other predictors of survival remain poorly characterized. The present study aims to perform a survival analysis and compare prognostic factors across pediatric, adult and geriatric cohorts.
Methods: The Surveillance, Epidemiology, and End Results database was employed to isolate cases of grade I-III intramedullary ependymomas from 2000-2021. Cases were stratified based on age: 0-19 years = pediatric, 20-64 years = adult, 65+ years = geriatric. Univariate Kaplan Meier followed by multivariate cox regression analyses were used to identify survival trends. Univariate comparison analyses compared age cohorts.
Results: 3444 cases were included. Geriatric (69±57.84 months) patients demonstrate poor survival compared to pediatric (107.5±69.43 months) and adult (106±70.66 months) cohorts (pediatric vs geriatric: HR=0.05 [0.02-0.11], p< 0.001; adult vs geriatric: HR=0.12 [0.09-0.17], p< 0.001). Compared to pediatric (90.7%) and adult patients (93.4%), geriatric patients (86.8%) underwent significantly less surgery (p < 0.001). Geriatric tumor size was significantly larger at diagnosis than adult and pediatric cohorts (24.59±18.55 vs 43.31±31.02 vs 31.97±24.42 mm, respectively, p< 0.001), though days from diagnosis to treatment were not different (p=0.29). Grade did not influence surgical resection (p=0.06). In multivariate analysis, sex did not influence pediatric survival, but otherwise surgical resection, male patients and grade 3 tumors significantly worsened overall and age-specific survival. Year of diagnosis did not impact overall (p=0.58) nor age-specific survival (pediatric: p=0.57, adult: p=0.68, geriatric: p=0.20).
Conclusion : Geriatric patients suffer from worse survival than those of younger age. Surgery remains protective across all ages, yet significantly less geriatric patients are receiving surgical resection. Across all ages, no significant survival gains have been made over the last two decades. Surgery should be considered more often in geriatric patients and further study is needed to optimize medical management to compliment surgical resection and improve survival.