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Liu H, Duan L, Li Z, Liu Y, Wang Y. Incidence and Survival of Patients With Malignant Primary Spinal Cord Tumors: A Population-Based Analysis. Neurospine 2024; 21:588-595. [PMID: 38955530 PMCID: PMC11224732 DOI: 10.14245/ns.2347300.650] [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: 12/03/2023] [Revised: 02/24/2024] [Accepted: 03/02/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE Epidemiological studies on spinal cord tumors are rare, and studies on primary intramedullary tumors are even rarer. The incidence and survival of patients with primary intramedullary spinal cord tumors have not been well documented. We aimed to study the incidence and survival of patients with primary spinal cord malignant and borderline malignant tumors based on data from the Surveillance, Epidemiology, and End Results (SEER) database and provide information for revealing the epidemiology and exploring the prognosis of patients with primary intramedullary tumors. METHODS Patients in the SEER database with microscopically diagnosed malignant and borderline malignant primary spinal cord tumors from 2000 and 2019 were included in this study. We analyzed the distribution of patients according to the demographic and clinical characteristics. Then, we extracted the incidence rate and 5-year relative survival for the whole cohort and different subgroups of the cohort. Finally, multivariate Cox proportional hazards models were used to analyze the independent prognostic factors associated with overall survival. RESULTS A total of 5,211 patients with malignant and borderline malignant primary spinal cord tumors were included in this cohort study. Ependymoma, astrocytoma (including oligodendrogliomas and glioblastoma), lymphoma and hemangioblastoma were the most common pathological types. The age-adjusted incidence rates of primary spinal cord ependymoma was 0.18 per 100,000. The incidence rate for females was significantly lower than that for males. The incidence rate was highest in Caucasian. The incidence rate of ependymoma was significantly higher than that of other pathological types. The incidence of astrocytoma was highest among people aged 0-19 years, the incidence of ependymoma was highest among people aged 40-59 years, and the incidence of lymphoma was highest among people aged 60 years or older. The 5-year observed survival and relative survival rates for the whole cohort were 82.80% and 86.00%, respectively. Patients diagnosed with ependymoma had significantly better survival than their counterparts. We also found the impact of surgery and chemotherapy on the prognosis of patients with different tumors varies a lot. CONCLUSION We conducted a population-based analysis of malignant and borderline malignant primary spinal cord tumors with the aim of revealing the epidemiology and survival of patients with primary intramedullary spinal cord tumors. Despite some shortcomings, this study provides valuable information to help us better understand the epidemiological characteristics of primary intramedullary spinal cord tumors.
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Affiliation(s)
- Huanbing Liu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Linnan Duan
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Zhibin Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yuanhao Liu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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Current management in the treatment of intramedullary ependymomas in children. Childs Nerv Syst 2022; 39:1183-1192. [PMID: 36574011 DOI: 10.1007/s00381-022-05814-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 12/17/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Current management of pediatric intramedullary ependymoma is extrapolated from adult series since large studies in children are unavailable. This has led us to share our experience with this rare tumor and compare it to the literature and to review and highlight important aspects of current management and point out inconsistencies. METHODS This is a retrospective analysis of patients with intramedullary ependymoma managed at our institution between 2004 and 2021. RESULTS During the study period, 5 patients were treated for intramedullary ependymoma. Cases of myxopapillary ependymoma were excluded. The mean age of our cohort was 11.2 years. We identified 4 cases of grade II ependymoma and 1 case of grade III ependymoma. Gross tumor removal (GTR) was achieved in two patients (40%) of patients. One patient was treated with radiotherapy for recurrence and two patients received chemotherapy. There were no cases of recurrence among patients treated with GTR, but in all patients treated with STR. Eighty percent of patients either improved or stayed stable neurologically. During follow-up (mean 73 months), 2 patients died of disease. CONCLUSION GTR and tumor grade remain the key prognostic factor of long-term tumor-free survival. Many questions prevail regarding outcomes, correct use of adjuvant therapy, and prognostic factors.
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Menon G, Srinivasan S, Nair R, Hegde A, Nair S. Spinal intramedullary tumors. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_263_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Evaluating the utility and quality of large administrative databases in pediatric spinal neurosurgery research. Childs Nerv Syst 2021; 37:2993-3001. [PMID: 34402953 DOI: 10.1007/s00381-021-05331-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to assess the quality of articles utilizing large administrative databases to answer questions related to pediatric spinal neurosurgery by quantifying their adherence to standard reporting guidelines. METHODS A systematic literature search was conducted with search terms including "pediatric" and "neurosurgery," associated neurosurgical diagnoses, and the names of known databases. Study abstracts were reviewed to identify clinical studies involving pediatric populations, spine-related pathology or procedures, and large administrative databases. Included studies were graded using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. RESULTS A total of 28 papers of the initial 1496 identified met inclusion criteria. These papers involved 10 databases and had a mean study period of 11.46 ± 12.27 years. The subjects of these research papers were undergoing treatment of scoliosis (n = 5), spinal cord injury (n = 5), spinal cord tumors (n = 9), and spine surgery in general (n = 9). The mean STROBE score was 19.41 ± 2.02 (out of 22). CONCLUSION Large administrative databases are commonly used within pediatric spine-related neurosurgical research to cover a broad spectrum of research questions and study topics. The heterogeneity of research to this point encourages the continued use of large databases to better understand treatment and diagnostic trends, perioperative and long-term outcomes, and rare pathologies within pediatric spinal neurosurgery.
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Gitto L, Serinelli S, Galbraith K, Williams M, Mirchia K, Galgano MA, Krishnamurthy S, de la Roza G, Viapiano MS, Walker JM, Jour G, Serrano J, DeLorenzo M, Snuderl M, Richardson TE. Anaplastic Transformation in Myxopapillary Ependymoma: A Report of 2 Cases and Review of the Literature. J Neuropathol Exp Neurol 2021; 79:1044-1053. [PMID: 32743660 DOI: 10.1093/jnen/nlaa077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/04/2020] [Accepted: 06/29/2020] [Indexed: 12/12/2022] Open
Abstract
Myxopapillary ependymoma (MPE) is a relatively common neoplasm arising primarily in the filum terminale/lumbosacral region of the spinal cord. It is designated as a grade I tumor in the most recent WHO Classification of Tumours of the CNS, although aggressive clinical behavior can be observed, especially in cases arising in an extradural location. Anaplastic transformation in MPE is exceedingly rare with <20 examples reported in the English literature, and consensus on diagnostic features and definitive grading remain to be determined. Here, we present 2 cases of recurrent MPE with anaplastic features, both of which had histology consistent with conventional MPE as well as areas with significant atypia, frequent mitotic figures, elevated Ki-67 proliferation indices (>10%-50%), necrosis, and focal vascular proliferation. Targeted next-generation sequencing panels revealed no definitive pathogenic mutations or fusion proteins in either case. Copy number profiling, methylation profiling, and t-Distributed Stochastic Neighbor Embedding were performed to investigate the molecular characteristics of these tumors. To the best of our knowledge, these are the first reported cases of MPE with anaplastic features with methylation profiling data. In addition, we review the literature and discuss common histologic and molecular findings associated with anaplastic features in MPE.
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Seaman SC, Bathla G, Park BJ, Woodroffe RW, Smith M, Menezes AH, Noeller J, Yamaguchi S, Hitchon PW. MRI characteristics and resectability in spinal cord glioma. Clin Neurol Neurosurg 2021; 200:106321. [PMID: 33268194 DOI: 10.1016/j.clineuro.2020.106321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The histopathology of intramedullary spinal cord tumors (IMSCT) can be suspected from the MRI features and characteristics. Ultimately, the confirmation of diagnosis requires surgery. This retrospective study addresses MRI features including homogeneity of enhancement, margination, and associated syrinx in intramedullary astrocytomas (IMA) and ependymomas (IME) that assist in diagnosis and predict resectability of these tumors. METHODS Single-center retrospective analysis of IMA and IME cases since 2005 extracted from the departmental registry/electronic medical records post IRB approval (IRB 201,710,760). We compared imaging findings (enhancement, margination, homogeneity, and associated syrinxes) between tumor types and examined patient outcomes. RESULTS There were 18 IME and 21 IMA. On preoperative MRI, IME was favored to have homogenous enhancement (OR 1.8, p = 0.0001), well-marginated (p < 0.0001, OR 0.019 [95 % CI 0.002-0.184]), and associated syrinx (p = 0.015, OR 0.192 [95 % CI 0.049-0.760]). Total excision, subtotal excision, and biopsy were performed in 12, 5, and 1 patients in the IME cohort, respectively. In the IMA group, tumors were heterogeneous and poorly marginated in 20 of the 21 patients. Total excision, subtotal excision, and biopsy were undertaken in 2, 13, and 6 patients, respectively. The success of excision was predicted by MRI, with a significant difference in the extent of resection between IME and IMA (X2 = 14.123, p = 0.001). In terms of outcome, ordinal regression analysis showed that well-margined tumors and those with homogeneous enhancement were associated with a better postoperative McCormick score. Extent of resection had statistically significant survival (p = 0.026) and recurrence-free survival (p = 0.008) benefits. CONCLUSION The imaging characteristics of IME and IMA have meaningful clinical significance. Homogeneity, margination, and associated syrinxes in IME can predict resectability and complexity of surgery.
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Affiliation(s)
- Scott C Seaman
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Girish Bathla
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Brian J Park
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Royce W Woodroffe
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Mark Smith
- Department of Radiation Oncology, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Arnold H Menezes
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Jennifer Noeller
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Satoshi Yamaguchi
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Patrick W Hitchon
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA.
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Lopez-Rivera V, Dono A, Abdelkhaleq R, Sheth SA, Chen PR, Chandra A, Ballester LY, Esquenazi Y. Treatment trends and overall survival in patients with grade II/III ependymoma: The role of tumor grade and location. Clin Neurol Neurosurg 2020; 199:106282. [PMID: 33045626 DOI: 10.1016/j.clineuro.2020.106282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/08/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Treatment of ependymoma (EPN) is guided by associated tumor features, such as grade and location. However, the relationship between these features with treatments and overall survival in EPN patients remains uncharacterized. Here, we describe the change over time in treatment strategies and identify tumor characteristics that influence treatment and survival in EPN. METHODS AND MATERIALS Using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 18 Registries (1973-2016) database, we identified patients with EPN microscopically confirmed to be grade II (EPN-GII) or III (EPN-GIII) tumors between 2004-2016. Overall survival (OS) was analyzed using Kaplan-Meier survival estimates and multivariable Cox proportional hazard models. A sub-analysis was performed by tumor location (supratentorial, posterior fossa, and spine). Change over time in rates of gross total resection (GTR), radiotherapy (RT), and chemotherapy (CS) were analyzed using linear regression, and predictors of treatment were identified using multivariable logistic regression models. RESULTS Between 2004-2016, 1,671 patients were diagnosed with EPN, of which 1,234 (74 %) were EPN-GII and 437 (26 %) EPN-GIII. Over the study period, EPN-GII patients underwent a less aggressive treatment (48 % vs 27 %, GTR; 60 % vs 30 %, RT; 22 % vs 2%, CS; 2004 vs 2016; p < 0.01 for all). Age, tumor size, location, and grade were positive predictors of undergoing treatment. Univariate analysis revealed that tumor grade and location were significantly associated with OS (p < 0.0001 for both). In multivariable Cox regression, tumor grade was an independent predictor of OS among patients in the cohort (grade III, HR 3.89 [2.84-5.33]; p < 0.0001), with this finding remaining significant across all tumor locations. CONCLUSIONS In EPN, tumor grade and location are predictors of treatment and overall survival. These findings support the importance of histologic WHO grade and location in the decision-making for treatment and their role in individualizing treatment for different patient populations.
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Affiliation(s)
- Victor Lopez-Rivera
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rania Abdelkhaleq
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sunil A Sheth
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, USA; Memorial Hermann Hospital-Texas Medical Center, Houston, TX, USA
| | - Peng R Chen
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, USA; Memorial Hermann Hospital-Texas Medical Center, Houston, TX, USA
| | - Ankush Chandra
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, USA; Memorial Hermann Hospital-Texas Medical Center, Houston, TX, USA
| | - Leomar Y Ballester
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA; Memorial Hermann Hospital-Texas Medical Center, Houston, TX, USA
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, USA; Memorial Hermann Hospital-Texas Medical Center, Houston, TX, USA; Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Achey RL, Vo S, Cioffi G, Gittleman H, Schroer J, Khanna V, Buerki R, Kruchko C, Barnholtz-Sloan JS. Ependymoma, NOS and anaplastic ependymoma incidence and survival in the United States varies widely by patient and clinical characteristics, 2000-2016. Neurooncol Pract 2020; 7:549-558. [PMID: 33014396 DOI: 10.1093/nop/npaa023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Ependymoma is a rare CNS tumor arising from the ependymal lining of the ventricular system. General differences in incidence and survival have been noted but not examined on a comprehensive scale for all ages and by histology. Despite the rarity of ependymomas, morbidity/mortality associated with an ependymoma diagnosis justifies closer examination. METHODS Incidence data were obtained from the Central Brain Tumor Registry of the United States in collaboration with the Centers for Disease Control and Prevention and the National Cancer Institute, and survival data from Surveillance Epidemiology and End Results, from 2000 to 2016 for anaplastic ependymoma and ependymoma, not otherwise specified (NOS). Age-adjusted incidence rates (IRs) per 100 000 person-years were analyzed by age, sex, race, and location. Survival analysis was performed with Kaplan-Meier curves and multivariable Cox proportional hazards models. RESULTS Incidence of anaplastic ependymoma was highest in ages 0 to 4 years. African American populations had lower incidence but had a 78% increased risk of death compared to white populations (hazard ratio [HR]: 1.78 [95% CI, 1.30-2.44]). Incidence was highest for anaplastic ependymoma in the supratentorial region. Adults (age 40+ years) had almost twice the risk of death compared to children (ages 0-14 years) (HR: 1.97 [95% CI, 1.45-2.66]). For ependymoma, NOS, subtotal resection had a risk of mortality 1.86 times greater than gross total resection ([HR: 1.86 [95% CI, 1.32-2.63]). CONCLUSIONS African American populations experienced higher mortality rates despite lower incidence compared to white populations. Extent of resection is an important prognostic factor for survival. This highlights need for further evaluation of treatment patterns and racial disparities in the care of patients with ependymoma subtypes.
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Affiliation(s)
- Rebecca L Achey
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sierra Vo
- Department of Mathematics, Applied Mathematics, and Statistics, Case Western Reserve, Cleveland, Ohio
| | - Gino Cioffi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Haley Gittleman
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Julia Schroer
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vishesh Khanna
- Department of Internal Medicine, Stanford University, Stanford, California
| | - Robin Buerki
- Department of Neurology, University Hospitals of Cleveland, Cleveland, Ohio
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Jill S Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Central Brain Tumor Registry of the United States, Hinsdale, Illinois
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Shi S, Jin MC, Koenig J, Gibbs IC, Soltys SG, Chang SD, Li G, Hayden Gephart M, Hiniker SM, Pollom EL. Stereotactic Radiosurgery for Pediatric and Adult Intracranial and Spinal Ependymomas. Stereotact Funct Neurosurg 2019; 97:189-194. [PMID: 31590165 DOI: 10.1159/000502653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/08/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE/BACKGROUND We report efficacy and toxicity outcomes with stereotactic radiosurgery (SRS) for intracranial and spinal ependymoma. METHODS We analyzed adult and pediatric patients with newly diagnosed or recurrent intracranial or spinal ependymoma lesions treated with SRS at our institution. Following SRS, local failure (LF) was defined as failure within or adjacent to the SRS target volume, while distant failure (DF) was defined as failure outside of the SRS target volume. Time to LF and DF was analyzed using competing risk analysis with death as a competing risk.Overall survival (OS) was calculated from the date of first SRS to the date of death or censored at the date of last follow-up using the Kaplan-Meier method. RESULTS Twenty-one patients underwent SRS to 40 intracranial (n = 30) or spinal (n = 10) ependymoma lesions between 2007 and 2018, most commonly with 18 or 20 Gy in 1 fraction. Median follow-up for all patients after first SRS treatment was 54 months (range 2-157). The 1-year, 2-year, and 5-year rates of survival among patients with initial intracranial ependymoma were 86, 74, and 52%, respectively. The 2-year cumulative incidences of LF and DF after SRS among intracranial ependymoma patients were 25% (95% CI 11-43) and 42% (95% CI 22-60), respectively. No spinal ependymoma patient experienced LF, DF, or death within 2 years of SRS. Three patients had adverse radiation effects. CONCLUSIONS SRS is a viable treatment option for intracranial and spinal ependymoma with excellent local control and acceptable toxicity.
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Affiliation(s)
- Siyu Shi
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Michael C Jin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Julie Koenig
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Iris C Gibbs
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Gordon Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Melanie Hayden Gephart
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA,
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
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Disparities among racial/ethnic groups of patients diagnosed with ependymoma: analyses from the Surveillance, Epidemiology and End Results (SEER) registry. J Neurooncol 2019; 144:43-51. [DOI: 10.1007/s11060-019-03214-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
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