Departments of Neurological Surgery, University of California, SanFrancisco, CA 94117 USA.
J Neurosurg Spine. 2013 Mar;18(3):226-35. doi: 10.3171/2012.12.SPINE12591. Epub 2013 Jan 11.
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.
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).
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).
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.
室管膜瘤是一种原发性中枢神经系统肿瘤，在成人脊柱中比在儿童脊柱中更为常见。先前的研究主要包括回顾性单机构经验或病例研究。在这项研究中，对报告的接受切除术治疗的脊髓室管膜瘤病例进行了全面的文献回顾，以确定肿瘤在脊柱轴上的位置是否传达了重要的预后信息。
在 PubMed 上进行了搜索，以确定所有包含脊髓室管膜瘤患者数据的论文。仅纳入分析明确报告肿瘤位置的接受室管膜瘤切除术的成年患者的病例。肿瘤位置分为 6 组：颈髓、颈、颈胸、胸、胸腰和圆锥+马尾。进行 Kaplan-Meier 生存和 Cox 回归分析，以确定肿瘤位置对无进展生存期（PFS）和总生存期（OS）的影响。
共确定了 447 例明确指出肿瘤位置的接受脊髓室管膜瘤切除术的患者。脊髓室管膜瘤最常见的位置是颈（32.0%）和圆锥+马尾（26.8%）区域。胸腰椎和颈髓区域的肿瘤最少（分别占总病例数的 5.1%和 3.4%）。圆锥+马尾区域的 WHO 分级 I 肿瘤比例最高，而位于这些区域之上的肿瘤主要为 WHO 分级 II 肿瘤。尽管下脊柱区域的肿瘤倾向于良性分级，但下 3 个区域（胸、胸腰、圆锥+马尾）的脊髓室管膜瘤患者的 PFS 明显短于上区域（颈髓、颈、颈胸）（p<0.001），但 OS 差异无统计学意义（p=0.131）。
脊柱轴不同区域的脊髓室管膜瘤具有不同的特征和临床行为。肿瘤分级、切除范围和 PFS 因肿瘤位置（上脊柱区与下脊柱区）而异，而 OS 则无差异。与上脊髓肿瘤相比，尽管较低的 WHO 分级病变更为常见，但较低的脊髓肿瘤复发率更高，这表明肿瘤在脊柱轴上的位置是一个重要的预后因素。
