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Wang C, Rooney MK, Alvarez-Breckenridge C, Beckham TH, Chung C, De BS, Ghia AJ, Grosshans D, Majd NK, McAleer MF, McGovern SL, North RY, Paulino AC, Perni S, Reddy JP, Rhines LD, Swanson TA, Tatsui CE, Tom MC, Yeboa DN, Li J. Outcomes and Pattern of Care for Spinal Myxopapillary Ependymoma in the Modern Era-A Population-Based Observational Study. Cancers (Basel) 2024; 16:2013. [PMID: 38893133 PMCID: PMC11171081 DOI: 10.3390/cancers16112013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
(1) Background: Myxopapillary ependymoma (MPE) is a rare tumor of the spine, typically slow-growing and low-grade. Optimal management strategies remain unclear due to limited evidence given the low incidence of the disease. (2) Methods: We analyzed data from 1197 patients with spinal MPE from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2020). Patient demographics, treatment modalities, and survival outcomes were examined using statistical analyses. (3) Results: Most patients were White (89.9%) with a median age at diagnosis of 42 years. Surgical resection was performed in 95% of cases. The estimated 10-year overall survival was 91.4%. Younger age (hazard ratio (HR) = 1.09, p < 0.001) and receipt of surgery (HR = 0.43, p = 0.007) were associated with improved survival. Surprisingly, male sex was associated with worse survival (HR = 1.86, p = 0.008) and a younger age at diagnosis compared to females. (4) Conclusions: This study, the largest of its kind, underscores the importance of surgical resection in managing spinal MPE. The unexpected association between male sex and worse survival warrants further investigation into potential sex-specific pathophysiological factors influencing prognosis. Despite limitations, our findings contribute valuable insights for guiding clinical management strategies for spinal MPE.
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Affiliation(s)
- Chenyang Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Michael K. Rooney
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | | | - Thomas H. Beckham
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Brian S. De
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Amol J. Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - David Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Nazanin K. Majd
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mary F. McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Susan L. McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Robert Y. North
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.D.R.)
| | - Arnold C. Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Subha Perni
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Jay P. Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Laurence D. Rhines
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.D.R.)
| | - Todd A. Swanson
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Claudio E. Tatsui
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.D.R.)
| | - Martin C. Tom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Debra N. Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
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Song C, Kim HS, Lee JH, Yoon YC, Lee S, Lee SH, Kim ES. Development of a novel prediction model for differential diagnosis between spinal myxopapillary ependymoma and schwannoma. Sci Rep 2024; 14:149. [PMID: 38167614 PMCID: PMC10762031 DOI: 10.1038/s41598-023-50806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
Spinal myxopapillary ependymoma (MPE) and schwannoma represent clinically distinct intradural extramedullary tumors, albeit with shared and overlapping magnetic resonance imaging (MRI) characteristics. We aimed to identify significant MRI features that can differentiate between MPE and schwannoma and develop a novel prediction model using these features. In this study, 77 patients with MPE (n = 24) or schwannoma (n = 53) who underwent preoperative MRI and surgical removal between January 2012 and December 2022 were included. MRI features, including intratumoral T2 dark signals, subarachnoid hemorrhage (SAH), leptomeningeal seeding, and enhancement patterns, were analyzed. Logistic regression analysis was conducted to distinguish between MPE and schwannomas based on MRI parameters, and a prediction model was developed using significant MRI parameters. The model was validated internally using a stratified tenfold cross-validation. The area under the curve (AUC) was calculated based on the receiver operating characteristic curve analysis. MPEs had a significantly larger mean size (p = 0.0035), higher frequency of intratumoral T2 dark signals (p = 0.0021), associated SAH (p = 0.0377), and leptomeningeal seeding (p = 0.0377). Focal and diffuse heterogeneous enhancement patterns were significantly more common in MPEs (p = 0.0049 and 0.0038, respectively). Multivariable analyses showed that intratumoral T2 dark signal (p = 0.0439) and focal (p = 0.0029) and diffuse enhancement patterns (p = 0.0398) were independent factors. The prediction model showed an AUC of 0.9204 (95% CI 0.8532-0.9876) and the average AUC for internal validation was 0.9210 (95% CI 0.9160-0.9270). MRI provides useful data for differentiating spinal MPEs from schwannomas. The prediction model developed based on the MRI features demonstrated excellent discriminatory performance.
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Affiliation(s)
- Chorog Song
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
| | - Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Sungjoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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