Metellus P, Barrie M, Figarella-Branger D, Chinot O, Giorgi R, Jouvet A, Guyotat J
Service de neurochirurgie du Professeur-Grisoli, hôpital de La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
Neurochirurgie. 2007 Jun;53(2-3 Pt 1):66-75. doi: 10.1016/j.neuchi.2006.11.006.
Ependymomas are rare intracranial tumors observed in adults. Prognostic factors as well as proper therapeutic management remain controversial. We report a retrospective study of 121 cases intracranial ependymomas diagnosed between 1990 and 2004 in adult patients. Mean age was 46 years with a 1/1 sex-ratio. Supratentorial and infratentorial localization was noted for 41 (33.9%) and 80 (66.1%) patients respectively. Total gross resection was achieved for 62.8% of tumors. WHO staging was grade II for 72.7% and III for 27.3%. Recurrence developed in 41 (33.9%) patients. Median follow-up was 70 months. The 5-year and 10-year overall survivals were 85 and 76% respectively; the respective progression-free survivals were 64 and 43%. At univariate analysis, age, KPS, localization, extent of surgery and histological grade were correlated with overall survival. At multivariate analysis age, location, histological grade and extent of surgery contributed most to prediction of overall survival. Concerning progression-free survival, univariate analysis found age, KPS, localization, extent of surgery, complementary treatment and histological grade to be correlated with recurrence. Multivariate analysis retained extent of surgery, histological grade and complementary treatment as the most important predictors of progression-free survival. This study demonstrated that extent of surgery and tumor grade are the two main prognostic factors in adult intracranial ependymomas with respect to overall and progression-free survival. Furthermore, our data suggest that postoperative radiotherapy significantly increases progression-free survival in patients with incompletely resected grade II tumors.
室管膜瘤是成人中罕见的颅内肿瘤。预后因素以及恰当的治疗管理仍存在争议。我们报告了一项对1990年至2004年间诊断为颅内室管膜瘤的121例成年患者的回顾性研究。平均年龄为46岁，男女比例为1/1。幕上和幕下定位分别见于41例（33.9%）和80例（66.1%）患者。62.8%的肿瘤实现了全切除。世界卫生组织（WHO）分级II级占72.7%，III级占27.3%。41例（33.9%）患者出现复发。中位随访时间为70个月。5年和10年总生存率分别为85%和76%；无进展生存率分别为64%和43%。单因素分析显示，年龄、KPS评分、肿瘤定位、手术范围和组织学分级与总生存率相关。多因素分析表明，年龄、肿瘤位置、组织学分级和手术范围对总生存率的预测贡献最大。关于无进展生存率，单因素分析发现年龄、KPS评分、肿瘤定位、手术范围、辅助治疗和组织学分级与复发相关。多因素分析确定手术范围、组织学分级和辅助治疗是无进展生存率的最重要预测因素。这项研究表明，对于总生存和无进展生存而言，手术范围和肿瘤分级是成人颅内室管膜瘤的两个主要预后因素。此外，我们的数据表明，术后放疗可显著提高II级肿瘤切除不完全患者的无进展生存率。
