Predictors of Progression-Free Survival in Patients With Spinal Intramedullary Ependymoma: A Multicenter Retrospective Study by the Neurospinal Society of Japan

Kentaro Naito, Daisuke Umebayashi, Ryu Kurokawa, Toshiki Endo, Masaki Mizuno, Minoru Hoshimaru, Phyo Kim, Kazutoshi Hida, Toshihiro Takami, Masahito Hara, Masahiro Aoyama, Taku Sugawara, Hiroaki Shimizu, Kotaro Ogihara, Atsushi Sugawara, Kazushige Itoki, Seiji Matsui, Seiji Shigekawa, Noritsugu Kunihiro, Shinji YamamotoTakao Yasuhara, Motoyuki Iwasaki, Shigeo Ueda, Yasuyuki Miyoshi, Hideki Hayashi, Nakayama Noriyuki, Toru Iwama, Hiroshi Nakagawa, Manabu Sumiyoshi, Yasukazu Hijikata, Hisaaki Uchikado, Hitoshi Fukuda, Tomoaki Nakai, Takashi Sasayama, Kazuhiko Mishima, Tomoo Inoue, Shunsuke Yano, Toru Sasamori, Nobuhiro Mikuni, Yukinori Akiyama, Tsuyoshi Hara, Gakuji Gondo, Mitsuhiro Yoshida, Hideki Komatani, Yuichi Takahashi, Kiyoshi Ito, Hisaharu Goto, Node Yasuhiro, Mizuki Watanabe, Yasunobu Ito, Yoshitaka Hirano, Teiji Tominaga, Hirokazu Takami, Jun Karakama, Hiroki Ohashi, Naoyuki Harada, Tetsuro Shingo, Satoshi Kawajiri, Tomohiro Yamauchi, Tetsuji Uno, Keisuke Takai, So Fujimoto, Yasufumi Otake, Yasuhiro Takeshima, Hiroyuki Nakase, Akihiko Saito, Daijiro Morimoto, Kyongsong Kim, Tatsuya Ohtonari, Hiroto Kageyama, Takafumi Mitsuhara, Yosuke Kuromi, Toshiyuki Takahashi, Ryo Kanematsu, Tatsushi Inoue, Toshitaka Seki, Kazuyoshi Yamazaki, Izumi Koyanagi, Kazuhisa Yoshifuji, Masashi Fujimoto, Misao Nishikawa, Takashi Yagi, Hiroyuki Kinouchi, Hidetoshi Murata, Mari Kitayama

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: Ependymoma is the most common spinal intramedullary tumor. Although clinical outcomes have been described in the literature, most of the reports were based on limited numbers of cases or been confined to institutional experience. The objective of this study was to analyze more detailed characteristics of spinal intramedullary ependymoma (SIE) and provide clinical factors associated with progression-free survival (PFS). METHODS: This retrospective observational multicenter study included consecutive patients with SIE in the cervical or thoracic spine treated surgically at a total of 58 institutions between 2009 and 2020. The results of pathological diagnosis at each institute were confirmed, and patients with myxopapillary ependymoma, subependymoma, or unverified histopathology were strictly excluded from this study. Outcome measures included surgical data, surgery-related complications, postoperative systemic adverse events, postoperative adjuvant treatment, postoperative functional condition, and presence of recurrence. RESULTS: This study included 324 cases of World Health Organization grade II (96.4%) and 12 cases of World Health Organization grade III (3.6%). Gross total resection (GTR) was achieved in 76.5% of cases. Radiation therapy (RT) was applied after surgery in 16 cases (4.8%), all of which received local RT and 5 of which underwent chemotherapy in combination. Functional outcomes were significantly affected by preoperative neurological symptoms, tumor location, extent of tumor resection, and recurrence. Multivariate regression analysis suggested that limited extent of tumor resection or recurrence resulted in poor functional outcomes. Multiple comparisons among the groups undergoing GTR, subtotal resection and biopsy, or partial resection of the tumor showed that the probability of PFS differed significantly between GTR and other extents of resection. CONCLUSION: When GTR can be safely obtained in the surgery for SIE, functional maintenance and longer PFS can be expected.

Original languageEnglish
Pages (from-to)1046-1056
Number of pages11
JournalNeurosurgery
Volume93
Issue number5
DOIs
Publication statusPublished - 01-11-2023

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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