Wostrack Maria, Ringel Florian, Eicker Sven O, Jägersberg Max, Schaller Karl, Kerschbaumer Johannes, Thomé Claudius, Shiban Ehab, Stoffel Michael, Friedrich Benjamin, Kehl Victoria, Vajkoczy Peter, Meyer Bernhard, Onken Julia
1Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich.
8Department of Neurosurgery, University Clinic Johannes Gutenberg-University Mainz.
J Neurosurg Spine. 2018 Jun;28(6):654-662. doi: 10.3171/2017.9.SPINE17494. Epub 2018 Mar 9.
OBJECTIVE Spinal ependymomas are rare glial neoplasms. Because their incidence is low, only a few larger studies have investigated this condition. There are no clear data concerning prognosis and therapy. The aim of the study was to describe the natural history, perioperative clinical course, and local tumor control of adult patients with spinal ependymomas who were surgically treated under modern treatment standards. METHODS The authors performed a multicenter retrospective study. They identified 158 adult patients with spinal ependymomas who had received surgical treatment between January 2006 and June 2013. The authors analyzed the clinical and histological aspects of these cases to identify the predictive factors for postoperative morbidity, tumor resectability, and recurrence. RESULTS Gross-total resection (GTR) was achieved in 80% of cases. At discharge, 37% of the patients showed a neurological decline. During follow-up the majority recovered, whereas 76% showed at least preoperative status. Permanent functional deterioration remained in 2% of the patients. Transient deficits were more frequent in patients with cervically located ependymomas (p = 0.004) and in older patients (p = 0.002). Permanent deficits were independently predicted only by older age (p = 0.026). Tumor progression was observed in 15 cases. The 5-year progression-free survival (PFS) rate was 80%, and GTR (p = 0.037), WHO grade II (p = 0.009), and low Ki-67 index (p = 0.005) were independent prognostic factors for PFS. Adjuvant radiation therapy was performed in 15 cases. No statistically relevant effects of radiation therapy were observed among patients with incompletely resected ependymomas (p = 0.079). CONCLUSIONS Due to its beneficial value for PFS, GTR is important in the treatment of spinal ependymoma. Gross-total resection is feasible in the majority of cases, with acceptable rates of permanent deficits. Also, Ki-67 appears to be an important prognostic factor and should be included in a grading scheme for spinal ependymomas.
目的 脊髓室管膜瘤是一种罕见的神经胶质瘤。由于其发病率较低，仅有少数较大规模的研究对该疾病进行过调查。目前尚无关于预后和治疗的明确数据。本研究的目的是描述在现代治疗标准下接受手术治疗的成年脊髓室管膜瘤患者的自然病程、围手术期临床过程及局部肿瘤控制情况。方法 作者开展了一项多中心回顾性研究。他们纳入了2006年1月至2013年6月期间接受手术治疗的158例成年脊髓室管膜瘤患者。作者分析了这些病例的临床和组织学特征，以确定术后发病、肿瘤可切除性及复发的预测因素。结果 80%的病例实现了全切除（GTR）。出院时，37%的患者出现神经功能下降。在随访期间，大多数患者恢复，76%的患者至少恢复到术前状态。2%的患者遗留永久性功能恶化。颈段室管膜瘤患者（p = 0.004）和老年患者（p = 0.002）出现短暂性神经功能缺损更为常见。仅年龄较大是永久性神经功能缺损的独立预测因素（p = 0.026）。观察到15例肿瘤进展。5年无进展生存期（PFS）率为80%，GTR（p = 0.037）、世界卫生组织（WHO）II级（p = 0.009）和低Ki-67指数（p = 0.005）是PFS的独立预后因素。15例患者接受了辅助放疗。在未完全切除的室管膜瘤患者中，未观察到放疗有统计学意义的效果（p = 0.079）。结论 由于GTR对PFS具有有益价值，其在脊髓室管膜瘤治疗中很重要。大多数病例可行全切除，永久性神经功能缺损发生率可接受。此外，Ki-67似乎是一个重要的预后因素，应纳入脊髓室管膜瘤的分级方案中。
