Survival Factors in 1580 Adults With Spinal Ependymoma: Insights From a Multicenter Oncology Database Publisher Pubmed



Almistarehi AH¹ ; Parker M¹ ; Xia Y¹ ; Hasanzadeh A² ; Horowitz MA¹ ; Raj D¹ ; Papali P¹ ; Davidar AD¹ ; Redmond KJ³ ; Bettegowda C¹ ; Witham T¹ ; Bydon A¹ ; Theodore N¹ ; Lubelski D¹
Source: World Neurosurgery Published:2024

Abstract

Background: Using a multi-institutional oncology database, we investigate the survival rates and the impacts of demographic, clinical, and management characteristics on overall survival among adult patients diagnosed with spinal ependymoma. Methods: Utilizing the SEER registry, patients with histologically or radiologically confirmed ependymomas were included. Factors impacting overall survival were analyzed using Kaplan-Meier survival curves and log-rank statistical analyses. Results: A total of 1,580 patients were included. Their mean ± standard deviation age was 46.68 ± 15.96 years, and 51.1% were women. Gross total resection (GTR) was achieved in 66.4% of patients. The 5- and 10-year survival rates were 96.7% and 95.4%, respectively. A multivariable backward Cox regression showed that age ≥65 years was a significant predictor for mortality (hazard ratio [HR]: 3.93; 95% confidence interval [CI]: 2.21–7.00; P < 0.001). Likewise, tumor grade 3 (HR: 6.36; 95% CI: 1.95–20.76; P = 0.002), tumor grade 4 (HR: 7.74; 95% CI: 3.97–15.11; P < 0.001), presence of extra-neural 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 GTR was significantly associated with improved overall survival compared with subtotal resection or nonsurgical management (HR: 0.42; 95% CI: 0.25–0.73; P = 0.002). There were 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 extra-neural metastasis were associated with worse overall survival, whereas radiotherapy's role remains unclear. © 2024 Elsevier Inc.