Pediatric infratentorial ependymoma: prognostic significance of anaplastic histology

Abstract Pediatric infratentorial ependymomas are difficult to cure. Despite the availability of advanced therapeutic modalities for brain tumors, total surgical resection remains the most important prognostic factor. Recently, histological grade emerged as an independent prognostic factor for intracranial ependymoma. We retrospectively reviewed the treatment outcome of 33 pediatric patients with infratentorial ependymoma. Progression-free survival (PFS) and overall survival (OS) rates were calculated and relevant prognostic factors were analyzed. Fourteen patients (42%) were under the age of 3 at diagnosis. Gross total resection was achieved in 16 patients (49%). Anaplastic histology was found in 13 patients (39%). Adjuvant therapies were delayed until progression in 12 patients (36%). Actuarial PFS rates were 64% in the first year and 29% in the fifth year. Actuarial OS rates were 91% in the first year and 71% in the fifth year. On univariate analysis, brainstem invasion (P = 0.047), anaplastic histology (P = 0.004), higher mitotic count (P = 0.001), and higher Ki-67 index (P = 0.004) were significantly related to a shorter PFS. Gross total resection (P = 0.029) and a greater age at diagnosis (P = 0.033) were significantly related to a longer PFS. On multivariate analysis, anaplastic histology alone was significantly related to a shorter PFS (P = 0.023). Gross total resection (P = 0.039) was significantly related to a longer overall survival (OS) on multivariate analysis. Anaplastic histology and gross total resection were the most important clinical factors affecting PFS and OS, respectively. Anaplastic histology, mitotic count, and Ki-67 index can be used as universal and easily available prognostic parameters in infratentorial ependymomas.

  • Content Type Journal Article
  • Category Clinical Study – Patient Study
  • Pages 1-8
  • DOI 10.1007/s11060-011-0699-x
  • Authors
    • Ji Hoon Phi, Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744 Republic of Korea
    • Kyu-Chang Wang, Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744 Republic of Korea
    • Sung-Hye Park, Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
    • Il Han Kim, Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
    • In-One Kim, Department of Diagnostic Radiology, Seoul National University Hospital, Seoul, Republic of Korea
    • Kyung Duk Park, Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Republic of Korea
    • Hyo Seop Ahn, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
    • Ji Yeoun Lee, Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744 Republic of Korea
    • Young-Je Son, Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
    • Seung-Ki Kim, Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744 Republic of Korea

http://www.springerlink.com/content/y7h2823lj34387l8/

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