Prognosis by tumor location in adults with spinal ependymomas

2013 ◽  
Vol 18 (3) ◽  
pp. 226-235 ◽  
Author(s):  
Michael C. Oh ◽  
Joseph M. Kim ◽  
Gurvinder Kaur ◽  
Michael Safaee ◽  
Matthew Z. Sun ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cox Regression ◽  
Statistical Significance ◽  
Cauda Equina ◽  
Tumor Location ◽  
Spinal Cord Tumors ◽  
Prognostic Information ◽  
Who Grade ◽  
Spinal Ependymoma ◽  
Spinal Axis

Object Ependymomas are primary central nervous system tumors that occur more frequently in the spines of adults than they do there in children. Previous studies consist mainly of retrospective single-institutional experiences or case studies. In this study, a comprehensive literature review was performed on reported cases of spinal ependymoma treated with resection to determine whether tumor location along the spinal axis conveys important prognostic information. Methods A PubMed search was performed to identify all papers that included data on patients with spinal ependymoma. Only cases involving adult patients who underwent ependymoma resection with a clearly reported tumor location were included for analysis. Tumor locations were separated into 6 groups: cervicomedullary, cervical, cervicothoracic, thoracic, thoracolumbar, and conus + cauda equina. Kaplan-Meier survival and Cox regression analyses were performed to determine the effect of tumor location on progression-free survival (PFS) and overall survival (OS). Results A total of 447 patients who underwent resection of spinal ependymomas with clearly indicated location of tumor were identified. The most common locations of spinal ependymomas were the cervical (32.0%) and conus + cauda equina (26.8%) regions. The thoracolumbar and cervicomedullary regions had the fewest tumors (accounting for, respectively, 5.1% and 3.4% of the total number of cases). The conus + cauda equina and thoracolumbar regions had the highest percentage of WHO Grade I tumors, while tumors located above these regions consisted of mostly WHO Grade II tumors. Despite the tendency for benign grades in the lower spinal regions, PFS for patients with spinal ependymomas in the lower 3 regions (thoracic, thoracolumbar, conus + cauda equina) was significantly shorter (p < 0.001) than for those with tumors in the upper regions (cervicomedullary, cervical, cervicothoracic), but the difference in OS did not achieve statistical significance (p = 0.131). Conclusions Spinal ependymomas along different regions of spinal axis have different characteristics and clinical behaviors. Tumor grade, extent of resection, and PFS varied by tumor location (upper vs lower spinal regions), while OS did not. Recurrence rates were higher for the lower spinal cord tumors, despite a greater prevalence of lower WHO grade lesions, compared with upper spinal cord tumors, suggesting that tumor location along the spinal axis is an important prognostic factor.

EPCO-01. MOLECULAR PROFILING OF SPINAL CORD EPENDYMOMA

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi1-vi1
Author(s):  
Erika Yamazawa ◽  
Shota Tanaka ◽  
Genta Nagae ◽  
Takayoshi Umeda ◽  
Taijun Hana ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Dna Methylation ◽  
Methylation Status ◽  
Neurofibromatosis Type ◽  
Methylation Pattern ◽  
Who Grade ◽  
Spinal Ependymoma ◽  
Fresh Frozen ◽  
Spinal Cord Ependymoma ◽  
The Difference

Abstract BACKGROUND Ependymomas are currently classified into 9 subgroups by DNA methylation profiles. Although spinal cord ependymoma (SP-EPN) is distinct from other tumors, diversity within SP-EPN is still unclear. Here, we used transcriptomic and epigenomic profiles to investigate the diversity among Japanese SP-EPN cases. MATERIALS AND METHODS We analyzed 57 SP-EPN patients (32 males and 25 females, aged from 18 to 78 years, median: 52), including two cases of neurofibromatosis type 2, five cases of grade 3 (WHO grade). We obtained transcriptome (RNA-seq) and DNA methylation (Infinium Methylation EPIC array) data from fresh frozen specimens of SP-EPN resected at the University of Tokyo Hospital and our collaborative groups. RESULTS Three cases had a previous intracranial ependymoma operation. Hierarchical clustering of the DNA methylation data showed that these three cases of intracranial origin as a different cluster from spinal origin. The 45 grade 2 spinal ependymoma showed a relatively homogenous methylation pattern. However, the methylation status of HOX gene cluster regions is compatible with the segment of origin, which reflects the cells of origins are derived after the determination of segment identity. RNA sequencing of 57 cases revealed two subgroups within grade 2. Gene ontology analysis of differentially expressed genes suggested the difference in metabolic state such as rRNA translation and mitochondrial respiration between the two expression subgroups. CONCLUSION Epigenetic analysis indicated the accurate body segment origin of SP-EPN. We observed that metabolic states could divide grade 2 spinal cord ependymoma into 2 subgroups and will present the relationship to clinicopathological information.

scholarly journals Surgical outcome of intradural extramedullary spinal cord tumors - Our experience at a tertiary health care center

2020 ◽  
Vol 1 (2) ◽  
pp. 103-109
Author(s):  
Gyanendra Joshi ◽  
Binod Bijukachhe ◽  
Javed Ahmad Khan
Keyword(s):  
Spinal Cord ◽  
Cauda Equina ◽  
Clinical Results ◽  
Spinal Tumors ◽  
Myxopapillary Ependymoma ◽  
Spinal Cord Tumors ◽  
Vas Score ◽  
Post Surgery ◽  
Intradural Extramedullary

Introduction: To report the treatment results of 19 patients who underwent excision of intradural extramedullary (IDEM) spinal tumors. Materials & Methods:  This is a retrospective study. Patients’ records were retrieved from the electronic database of Grande International Hospital. There were 19 IDEM spinal tumors excised over a period of 6 years between January 2013 and August 2019 by a single surgeon. There were 11 (57.9%) males and 8 (42.1%) females with an average age of 48.37±21.87 years (range, 5-79 years). The mean postoperative follow-up period was 12.87±14.88 months (range, 15 days - 60 months). The histopathological findings, locations of the tumors, and clinical results were analyzed. Neurological findings were evaluated using ASIA grading system and pain was evaluated using VAS score. Results:  Histopathologically the tumors were: 8 meningioma (42.1%), 4 schwannoma (21.1%), 4 neurofibroma (21.1%), 1 dermoid cyst (5.3%), 1 lipoma (5.3%), and 1 myxopapillary ependymoma (5.3%). Tumor locations were: dorsal in 10 (52.6%), lumbar in 5 (26.3%), lumbosacral in 2 (10.5%), dorsolumbar in 1 (5.3%), and cervical in 1 (5.3%) patient. Neurologic status of 7 patients was normal and 12 had neurologic involvement with 3 patients having Cauda Equina Syndrome (CES) preoperatively. At the final follow-up, 3-grade, 2-grade and 1-grade improvement in ASIA score was observed in 1, 6 and 1 cases, respectively. There was no change in the ASIA grade in 1 case. All 3 cases of CES achieved full neural recovery. Preoperative VAS score was 9.21±1.08 and improved significantly to 0.74±1.62 after surgery. Neurological improvement was seen in 91.67% with complete recovery in 75% of the cases and not a single case deteriorated neurologically post-surgery. Conclusion:  Most intradural-extramedullary spinal cord tumors are mostly benign and good clinical results can be obtained when adequately treated with surgery.

Surgical outcomes of spinal cord and cauda equina ependymoma: Postoperative motor status and recurrence for each WHO grade in a multicenter study

2018 ◽  
Vol 23 (4) ◽  
pp. 614-621 ◽  
Author(s):  
Kazuyoshi Kobayashi ◽  
Kei Ando ◽  
Fumihiko Kato ◽  
Tokumi Kanemura ◽  
Koji Sato ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Multicenter Study ◽  
Surgical Outcomes ◽  
Cauda Equina ◽  
Who Grade

scholarly journals Prognosis by tumor location for pediatric spinal cord ependymomas

2013 ◽  
Vol 11 (3) ◽  
pp. 282-288 ◽  
Author(s):  
Michael C. Oh ◽  
Eli T. Sayegh ◽  
Michael Safaee ◽  
Matthew Z. Sun ◽  
Gurvinder Kaur ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cox Regression ◽  
Pediatric Population ◽  
Progression Free Survival ◽  
Tumor Location ◽  
Conus Medullaris ◽  
Cervical Region ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Pubmed Search

Object Ependymoma is a common CNS tumor in children, with spinal cord ependymomas making up 13.1% of all ependymomas in this age group. The clinical features that affect prognosis in pediatric spinal cord ependymomas are not well understood. A comprehensive literature review was performed to determine whether a tumor location along the spinal cord is prognostically significant in children undergoing surgery for spinal cord ependymomas. Methods A PubMed search was performed to identify all papers that contained data on patients with spinal cord ependymomas. Only pediatric patients (age < 18 years) who underwent resection with a clearly reported tumor location were included in the analysis. Myxopapillary tumors were excluded from study. Tumor location was subdivided into 6 regions: cervicomedullary, cervical, cervicothoracic, thoracic, thoracolumbar, and conus medullaris. Kaplan-Meier survival and Cox regression analyses were performed to determine the effects of tumor location on progression-free survival (PFS) and overall survival (OS). Results Fifty-eight patients who underwent resection of spinal cord ependymomas were identified. Ependymomas were located all along the spinal cord but occurred with the highest frequency in the cervical region (29.3%). Progression-free survival was significantly better in patients with tumors arising in the upper portion of the spinal cord (p = 0.031), which remained significant in the multivariate Cox regression analysis (p < 0.05). Moreover, OS was significantly better in patients with upper spinal cord ependymomas than in those harboring ependymomas in the lower spinal cord (p = 0.048). Conclusions Although more common in adults, spinal ependymomas can occur anywhere along the spinal cord in the pediatric population; however, tumors occurring in the lower half of the spinal cord carry a worse prognosis with shorter PFS and OS. By comparison, ependymomas in the upper spinal cord recur later and less frequently, with little or no mortality in this patient group.

scholarly journals A comprehensive model including preoperative peripheral blood inflammatory markers for prediction of the prognosis of diffuse spinal cord astrocytoma following surgery

2021 ◽  
Author(s):  
Bo Pang ◽  
Rui-Chao Chai ◽  
Yao-Wu Zhang ◽  
Yu-Zhou Chang ◽  
Wei-Hao Liu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Peripheral Blood ◽  
Inflammatory Markers ◽  
Prognostic Model ◽  
Cox Regression ◽  
Histological Grade ◽  
Ki 67 ◽  
Who Grade ◽  
Grade Ii ◽  
Spinal Cord Astrocytoma

Abstract Purpose Due to the rarity of diffuse spinal cord astrocytoma, an effective model is still lacking to stratify their prognosis. Here, we aimed to establish a prognostic model through comprehensively evaluating clinicopathological features and preoperative peripheral blood inflammatory markers in 89 cases. Methods We performed univariate and multivariate Cox regression to identify prognosis factors. The Kaplan–Meier curves and ROC curves were employed to compare the prognostic value of selected factors. Results In addition to clinicopathological factors, we revealed the preoperative peripheral blood leukocyte count, neutrophils-to-lymphocytes ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were also significantly correlated with overall survival of spinal cord astrocytoma in univariate Cox regression, and NLR was still significant in multivariate Cox analysis. Further, we demonstrated that NLR ≤ 3.65 and preoperative McCormick score (MMS) ≤ 3 were independently correlated with better survival of WHO grade IV tumors. Meanwhile, Ki-67 < 10% and resection extent ≥ 90% were independent prognostic factors in WHO grade II/III tumors. Finally, we developed a prognostic model that had better predictive efficiencies than WHO grade and histological grade for 1-year (AUC = 76.6), 2- year (AUC = 80.9), and 3-year (AUC = 80.3) survival. This model could classify tumors into 4 classifications with increasingly poor prognosis: 1, WHO grade II/III, with Ki-67 < 10% and resection extent ≥ 90%; 2, WHO grade II/III, Ki-67 ≥ 10% or resection < 90%; 3, WHO grade IV, NLR ≤ 3.65 and MMS ≤ 3; 4, WHO grade IV, with NRL > 3.65 or MMS = 4. Conclusion We successfully constructed a comprehensive prognostic model including preoperative peripheral blood inflammatory markers, which can stratify diffuse spinal cord astrocytoma into 4 subgroups.

scholarly journals Prognosticki faktori resektabilnog primarnog nemikrocelularnog karcinoma bronha

2003 ◽  
Vol 50 (2) ◽  
pp. 61-70 ◽  
Author(s):  
Dragan Subotic ◽  
Dragan Mandaric ◽  
Ljiljana Andric ◽  
Nikola Atanasijadis ◽  
Milan Gajic
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Cox Regression ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Tumor Location ◽  
Tumor Diameter ◽  
Incomplete Resection ◽  
Cox Regression Analysis ◽  
Tumor Pathology

This study represents the univariate and multivariate analysis of prognostic factors of resectable non small cell lung cancer (NSCLC) that included 360 patients who underwent a surgical treatment because of primary (NSCLC) in the aforementioned institution in a period between 1985 and 1992. Patients with incomplete resection were rejected, perioperative deaths were not included in the analysis. In the analyzed group there were 293(81.38%) males and 67(18.62%) females - M:F ratio 4.37:1. Age of the operated patients was 36-75 years with the mean age of 55.15 years. Right-sided tumours existed in 197(54.72%) patients, left-sided tumors in 163(45.28%) patients. Based on pTNM, 157, 65, 114, 18 and 6 patients were classified into stages I, II, IIIA, IIIB and IV respectively. In the univariate analysis, survival curves were obtained using the life table method, with the statistical analysis of the obtained data using the Gehan-Wilcoxon method. In the multivariate analysis - Cox regression analysis was performed. Multivariate analysis found only T-stage, N-stage and the stage of the disease as significant independent prognostic factors. Mode of influence of factors that were found significant in the univariate analysis (age >60 years, tumor diameter > 60 mm, involvement of the visceral pleura, indirect tumor signs) is discussed and compared with literature data. Survival differences depending on other factors (tumor location, bronchoscopic aspect, extent of the resection), although without statistical significance, can be useful for the clinician, in the same time contributing to the better comprehension of information's obtained by basical investigations, especially of lymphatic spread of the disease and tumor pathology.

scholarly journals Role of Diffusion Tensor Imaging Parameters in the Characterization and Differentiation of Infiltrating and Non-Infiltrating Spinal Cord Tumors

2019 ◽  
Vol 30 (4) ◽  
pp. 739-747
Author(s):  
Edyta Maj ◽  
Barbara Szemplińska ◽  
Wojciech Szeszkowski ◽  
Marek Prokopienko ◽  
Andrzej Cieszanowski ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Diffusion Tensor Imaging ◽  
Diffusion Tensor ◽  
Statistical Significance ◽  
Spinal Tumors ◽  
Spinal Cord Tissue ◽  
Peritumoral Edema ◽  
Spinal Cord Tumors ◽  
Tumor Mass ◽  
Significant Difference

Abstract Background and Purpose Recent attempts to utilize diffusion tensor imaging (DTI) to identify the extent of microinfiltration of a tumor in the brain have been successful. It was therefore speculated that this technique could also be useful in the spinal cord. The aim of this study was to differentiate between infiltrating and noninfiltrating intramedullary spinal tumors using DTI-derived metrics. Material and Methods The study group consisted of 6 patients with infiltrating and 12 with noninfiltrating spinal cord tumors. Conventional magnetic resonance imaging (MRI) with gadolinium administration was performed followed by DTI. Fractional anisotropy (FA), diffusivity (TRACE) and apparent diffusion coefficient (ADC) were measured in the enhancing tumor mass, peritumoral margins, peritumoral edema and normal appearing spinal cord. The results were compared using non-parametric Mann–Whitney U test with statistical significance p < 0.05. Results In peritumoral margins the FA values were significantly higher in the noninfiltrating compared to the infiltrating tumors (p < 0.007), whereas TRACE values were significantly lower (p < 0.017). The results were similar in peritumoral edema. The FA values in the tumor mass showed no significant differences between the two groups while TRACE showed a statistically significant difference (p < 0.003). There was no statistical difference in any parameters in normal appearing spinal cord. Conclusion Quantitative analysis of DTI parameters of spinal cord tissue surroundings spinal masses can be useful for differentiation between infiltrating and non-infiltrating intramedullary spinal tumors.

scholarly journals PATH-33. EPIGENOMIC ANALYSIS OF SPINAL EPENDYMOMA

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii171-ii171
Author(s):  
Erika Yamazawa ◽  
Shota Tanaka ◽  
Nagae Genta ◽  
Meguro Hiroko ◽  
Takayoshi Umeda ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Dna Methylation ◽  
Profile Analysis ◽  
Neurofibromatosis Type ◽  
Methylation Data ◽  
Who Grade ◽  
Spinal Ependymoma ◽  
Dna Methylation Profile ◽  
Spinal Cord Ependymoma ◽  
The University

Abstract BACKGROUND Ependymomas commonly occur in the fourth ventricle and the spinal cord. Gross total resection, age and WHO grade are known prognostic factors. Ependymomas are currently classified into 9 distinct subgroups by DNA methylation profile analysis. Spinal cord ependymoma is distinct from other subgroups. To investigate heterogeneity within spinal cord ependymoma, we examined DNA methylation profiles. MATERIALS AND METHODS We used Infinium MethylationEPIC array (illumina) to obtain DNA methylation data from frozen specimens of spinal ependymoma resected at the University of Tokyo, Osaka City University, and Tokyo Metropolitan Neurological Hospital. Japan Pediatric Molecular Neuro-Oncology Group provided methylation data for 11 reported cases. Cluster analysis was performed using Cluster3.0. RESULTS We analyzed 34 patients, 21 male and 13 female, aged from 18 to 76 years (median 50.5 years), including 2 cases with neurofibromatosis type 2. WHO grade was grade_3 in 2 cases and grade_2 in others. Clustering of the DNA methylation data showed that WHO grade_3 cases tended to be classified into a subgroup distinct from other cases. CONCLUSION This is the largest DNA methylation profiling study on spinal cord ependymoma to date. The study may suggest a new subgroup correlated with higher WHO grade.

scholarly journals Refining the treatment of spinal cord lesions: experience from 500 cases

2021 ◽  
Vol 50 (5) ◽  
pp. E22
Author(s):  
Manfred Westphal ◽  
Klaus C. Mende ◽  
Sven O. Eicker
Keyword(s):  
Spinal Cord ◽  
Pediatric Population ◽  
Cauda Equina ◽  
Treatment Strategies ◽  
Complete Removal ◽  
Vascular Lesions ◽  
Incomplete Resection ◽  
Intramedullary Tumors ◽  
Who Grade ◽  
Cavernous Hemangiomas

OBJECTIVE Tumorous lesions of the spinal cord, as well as some vascular lesions like cavernous hemangiomas, demand careful consideration as to the indication and approach for surgery. As these lesions are rare in any departmental series, refinement of treatment strategies evolves over long periods. In this context, the authors evaluated a series of 500 intramedullary lesions for approach, technique, outcome, complications, and follow-up. METHODS Five hundred intramedullary lesions in 460 patients were treated with a continuously evolving departmental strategy between 1985 and 2020. No lesions of the cauda equina or filum terminale were included. The focus of the evaluation was on the adaptation of exposure, resective methodology, sequelae, imaging, and rate of recurrence. Thirty-seven patients were children at the time of diagnosis. RESULTS Among the 348 neoplastic lesions, the largest subtype was ependymoma (n = 192, 55.2%), followed by astrocytoma (n = 89, 25.6%). As a trend, metastases (n = 21) have become more frequent and more apparent only in the past 15 years. Reoperations for recurrent or progressive cases or referrals after incomplete resection were performed in 56 cases, mostly for progressive diffuse or pilocytic astrocytomas. Among the vascular lesions, 68 (54.8%) were hemangioblastomas, followed by 56 (45.2%) cavernous hemangiomas. All intramedullary tumors were approached through a midline myelotomy, refining an en bloc resection technique for endophytic tumors to increase the rate of radical resection. Cavernous hemangiomas reaching the surface and hemangioblastomas were approached directly. Complete removal was possible in 77.2% of endophytic tumors but in only 41.7% of diffuse tumors. All WHO grade II diffuse astrocytomas, WHO grade III tumors, and glioblastoma progressed despite treatment according to standard regimens. Vascular lesions were regularly removed completely, with only 1 recurrence of a large hemorrhagic thoracic cavernous hemangioma. The major sequelae were sensory deficits and neuropathic pain. Stabilizing instrumentation was placed in 5 cases of spinal deformity, mostly when more than 4 levels were affected, and in the pediatric population. CONCLUSIONS In a large series of intramedullary surgeries, refinement of treatment strategies related to exposure, implementation of intraoperative adjuncts such as ultrasound, intraoperative neuromonitoring, resective strategies, and reconstruction were evaluated. The authors found that for almost any defined, endophytic medullary lesion, a safe and complete removal can be offered.

Impact of Tumor Histology on Resectability and Neurological Outcome in Primary Intramedullary Spinal Cord Tumors

Neurosurgery ◽  
2015 ◽  
Vol 76 (suppl_1) ◽  
pp. S4-S13 ◽  
Author(s):  
Isaac O. Karikari ◽  
Shahid M. Nimjee ◽  
Tiffany R. Hodges ◽  
Erin Cutrell ◽  
Betsy D. Hughes ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neurological Outcome ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Neurological Outcomes ◽  
Tumor Histology ◽  
The Impact

Abstract BACKGROUND: Surgical outcomes for intramedullary spinal cord tumors are affected by many variables including tumor histology and preoperative neurological function. OBJECTIVE: To analyze the impact of tumor histology on neurological outcome in primary intramedullary spinal cord tumors. METHODS: A retrospective review of 102 consecutive patients with intramedullary spinal cord tumors treated at a single institution between January 1998 and March 2009. RESULTS: Ependymomas were the most common tumors with 55 (53.9%), followed by 21 astrocytomas (20.6%), 12 hemangioblastomas (11.8%), and 14 miscellaneous tumors (13.7%). Gross total resection was achieved in 50 ependymomas (90.9%), 3 astrocytomas (14.3%), 11 hemangioblastomas (91.7%), and 12 miscellaneous tumors (85.7%). At a mean follow-up of 41.8 months (range, 1-132 months), we observed recurrences in 4 ependymoma cases (7.3%), 10 astrocytoma cases (47.6%), 1 miscellaneous tumor case (7.1%), and no recurrence in hemangioblastoma cases. When analyzed by tumor location, there was no difference in neurological outcomes (P = .66). At the time of their last follow-up visit, 11 patients (20%) with an ependymoma improved, 38 (69%) remained the same, and 6 (10.9%) worsened. In patients with an astrocytoma, 1 (4.8%) improved, 10 (47.6%) remained the same, and 10 (47.6%) worsened. One patient (8.3%) with a hemangioblastoma improved and 11 (91.7%) remained the same. No patient with a hemangioblastoma worsened. In the miscellaneous tumor group, 2 (14.3%) improved, 10 (71.4%) remained the same, and 2 (14.3%) worsened. Preoperative neurological status (P = .02), tumor histology (P = .005), and extent of resection (P &lt; .0001) were all predictive of functional neurological outcomes. CONCLUSION: Tumor histology is the most important predictor of neurological outcome after surgical resection because it predicts resectability and recurrence.

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