Post-Doctoral Neurosurgery Research Fellow Johns Hopkins University Johns Hopkins University School of Medicine Baltimore, MD, US
Disclosure(s):
Abdel-Hameed Al-Mistarehi, MD: No financial relationships to disclose
Introduction: This study was conducted in light of the rarity of spinal ependymomas, and most literature is limited to single-center retrospective case series. We aim to investigate the survival rates and the impacts of demographic and clinical characteristics on overall survival among adult patients diagnosed with spinal ependymoma.
Methods: The Surveillance, Epidemiology, and End Results (SEER) database was utilized to include patients diagnosed with histologically or radiologically confirmed ependymomas between 2000 and 2019. Survival rates over 5 and 10 years and overall survival were measured. A multivariate backward Cox regression analysis was conducted to investigate the predictors of overall survival.
Results: A total of 1,580 patients were included. Their mean±SD age was 46.68±15.96 years, and 51.1% were women. Gross total resection was achieved in 66.4% of patients. The 5-year and 10-year survival rates were 96.7% and 95.4%, respectively. Multivariable analysis showed that age ≥65 was a significant predictor for mortality (HR: 3.93, 95% CI: 2.21 – 7.00; p< 0.001). Likewise, tumor grade III (HR: 6.36, 95% CI: 1.95 – 20.76; p=0.002), tumor grade IV (HR: 7.74, 95% CI: 3.97 – 15.11; p< 0.001), presence of extraneural metastasis (HR: 13.81, 95% CI: 3.67 – 51.96; p< 0.001), and receiving radiotherapy (HR: 2.50, 95% CI: 1.50 – 4.19; p< 0.001) were significant risk factors for mortality, while gross total resection was a significant predictor of good prognosis compared to sub-total resection or non-surgical management (HR: 0.42, 95% CI: 0.25– 0.73; p=0.002). No significant effects for gender, race, marital status, income, residential area, chemotherapy, tumor size, and the presence of other benign or malignant tumors on the survival hazards (p>0.05 for each).
Conclusion : Early diagnosis and surgical management of spinal ependymomas, such as GTR, were associated with remarkable survival benefits. Old age, high-grade spinal ependymoma, and extraneural metastasis were associated with bad prognosis, whereas radiotherapy's role remains ambiguous.
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