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Pathology of Spinal Ependymomas: An Institutional Experience Over 25 Years in 134 Patients

Tarapore, Phiroz E. MD*; Modera, Peter BS; Naujokas, Agne DO; Oh, Michael C. MD, PhD*; Amin, Beejal MD*; Tihan, Tarik MD, PhD; Parsa, Andrew T. MD, PhD*; Ames, Christopher P. MD*; Chou, Dean MD*; Mummaneni, Praveen V. MD*; Weinstein, Phillip R. MD*

doi: 10.1227/01.neu.0000430764.02973.78
Research-Human-Clinical Studies

BACKGROUND: Ependymomas constitute approximately 40% of primary intraspinal tumors. Current World Health Organization (WHO) grading may not correlate with observed progression-free survival (PFS).

OBJECTIVE: This retrospective study of prospectively collected data examines whether PFS is influenced by the histological grade or by the extent of resection. It also analyzes the usage and effectiveness of postoperative adjuvant radiotherapy.

METHODS: We reviewed 134 consecutive patients with ependymomas of all grades. Pathology slides were re-reviewed and the histological grades were confirmed by a single neuropathologist. Postoperative residual or recurrence was evaluated with follow-up magnetic resonance imaging.

RESULTS: There were 85 male and 49 female patients, ranging from 10 to 79 (median 41) years of age. Thirty patients had WHO grade I tumors, 101 had grade II tumors, and 3 had grade III tumors. Kaplan-Meier analysis of PFS demonstrated a mean duration of 6 years for grade I, 14.9 years for grade II, and 3.7 years for grade III (P < .001). In grade II ependymomas, mean PFS was 11.2 years with subtotal resection and 17.8 years with gross total resection (P < .01). PFS of patients who underwent subtotal resection was not significantly changed by adjuvant radiotherapy (P < .36).

CONCLUSION: Patients with grade II ependymoma have significantly longer PFS than patients with grade I ependymoma. The extent of resection did not affect PFS in grade I ependymoma but it did in grade II. Contrary to its higher grade, WHO grade II ependymoma carries a better prognosis than WHO grade I ependymoma.

ABBREVIATIONS: ANOVA, analysis of variance

AWD, alive with disease

DOC, dead of concurrent/intercurrent disease

DUC, dead of unknown cause

GTR, gross total resection

NED, alive with no evidence of disease

PFS, progression-free survival

STR, subtotal resection

WHO, World Health Organization

XRT, adjuvant radiotherapy

*Department of Neurosurgery, University of California, San Francisco, San Francisco, California;

Department of Pathology, University of California, San Francisco, San Francisco, California

Correspondence: Phiroz E. Tarapore, MD, Department of Neurosurgery, University of California, San Francisco, 505 Parnassus Ave, Rm M779, San Francisco, CA 94143. E-mail:

Received October 14, 2012

Accepted April 23, 2013

Copyright © by the Congress of Neurological Surgeons