Departments of 1 Neurosurgery and.
Temple University Medical School, Philadelphia, Pennsylvania.
J Neurosurg. 2016 Aug;125(2):410-8. doi: 10.3171/2015.7.JNS151187. Epub 2016 Jan 8.
OBJECTIVE Survival rates and prognostic factors for supratentorial hemispheric ependymomas have not been determined. The authors therefore designed a retrospective study to determine progression-free survival (PFS), overall survival (OS), and prognostic factors for hemispheric ependymomas. METHODS The study population consisted of 8 patients from our institution and 101 patients from the literature with disaggregated survival information (n = 109). Patient age, sex, tumor side, tumor location, extent of resection (EOR), tumor grade, postoperative chemotherapy, radiation, time to recurrence, and survival were recorded. Kaplan-Meier survival analyses and Cox proportional hazard models were completed to determine survival rates and prognostic factors. RESULTS Anaplastic histology/WHO Grade III tumors were identified in 62% of cases and correlated with older age. Three-, 5-, and 10-year PFS rates were 57%, 51%, and 42%, respectively. Three-, 5-, and 10-year OS rates were 77%, 71%, and 58%, respectively. EOR and tumor grade were identified on both Kaplan-Meier log-rank testing and univariate Cox proportional hazard models as prognostic for PFS and OS. Both EOR and tumor grade remained prognostic on multivariate analysis. Subtotal resection (STR) predicted a worse PFS (hazard ratio [HR] 4.764, p = 0.001) and OS (HR 4.216, p = 0.008). Subgroup survival analysis of patients with STR demonstrated a 5- and 10-year OS of 28% and 0%, respectively. WHO Grade III tumors also had worse PFS (HR 10.2, p = 0.004) and OS (HR 9.1, p = 0.035). Patients with WHO Grade III tumors demonstrated 5- and 10-year OS of 61% and 46%, respectively. Postoperative radiation was not prognostic for PFS or OS. CONCLUSIONS A high incidence of anaplastic histology was found in hemispheric ependymomas and was associated with older age. EOR and tumor grade were prognostic factors for PFS and OS on multivariate analysis. STR or WHO Grade III pathology, or both, predicted worse overall prognosis in patients with hemispheric ependymoma.
尚未确定幕上脑半球室管膜瘤的生存率和预后因素。因此，作者设计了一项回顾性研究，以确定半球室管膜瘤的无进展生存期（PFS）、总生存期（OS）和预后因素。
研究人群包括来自我们机构的 8 名患者和文献中具有离散生存信息的 101 名患者（n=109）。记录患者年龄、性别、肿瘤侧、肿瘤位置、切除程度（EOR）、肿瘤分级、术后化疗、放疗、复发时间和生存情况。进行 Kaplan-Meier 生存分析和 Cox 比例风险模型以确定生存率和预后因素。
62%的病例为间变组织学/世界卫生组织（WHO）分级 III 级肿瘤，与年龄较大有关。3 年、5 年和 10 年 PFS 率分别为 57%、51%和 42%。3 年、5 年和 10 年 OS 率分别为 77%、71%和 58%。EOR 和肿瘤分级在 Kaplan-Meier 对数秩检验和单变量 Cox 比例风险模型中均被确定为 PFS 和 OS 的预后因素。EOR 和肿瘤分级在多变量分析中仍然具有预后意义。次全切除（STR）预测 PFS（危险比[HR]4.764，p=0.001）和 OS（HR4.216，p=0.008）更差。STR 患者的亚组生存分析显示，5 年和 10 年 OS 分别为 28%和 0%。WHO 分级 III 级肿瘤的 PFS（HR10.2，p=0.004）和 OS（HR9.1，p=0.035）也较差。WHO 分级 III 级肿瘤患者的 5 年和 10 年 OS 分别为 61%和 46%。术后放疗对 PFS 或 OS 无预后意义。
半球室管膜瘤中发现间变组织学的发生率较高，与年龄较大有关。EOR 和肿瘤分级是多变量分析中 PFS 和 OS 的预后因素。STR 或 WHO 分级 III 级病理，或两者兼而有之，预测半球室管膜瘤患者的整体预后更差。
