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Pediatric infratentorial ependymoma: prognostic significance of anaplastic histology

  • Clinical Study – Patient Study
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Abstract

Pediatric infratentorial ependymomas are difficult to cure. Despite the availability of advanced therapeutic modalities for brain tumors, total surgical resection remains the most important prognostic factor. Recently, histological grade emerged as an independent prognostic factor for intracranial ependymoma. We retrospectively reviewed the treatment outcome of 33 pediatric patients with infratentorial ependymoma. Progression-free survival (PFS) and overall survival (OS) rates were calculated and relevant prognostic factors were analyzed. Fourteen patients (42%) were under the age of 3 at diagnosis. Gross total resection was achieved in 16 patients (49%). Anaplastic histology was found in 13 patients (39%). Adjuvant therapies were delayed until progression in 12 patients (36%). Actuarial PFS rates were 64% in the first year and 29% in the fifth year. Actuarial OS rates were 91% in the first year and 71% in the fifth year. On univariate analysis, brainstem invasion (P = 0.047), anaplastic histology (P = 0.004), higher mitotic count (P = 0.001), and higher Ki-67 index (P = 0.004) were significantly related to a shorter PFS. Gross total resection (P = 0.029) and a greater age at diagnosis (P = 0.033) were significantly related to a longer PFS. On multivariate analysis, anaplastic histology alone was significantly related to a shorter PFS (P = 0.023). Gross total resection (P = 0.039) was significantly related to a longer overall survival (OS) on multivariate analysis. Anaplastic histology and gross total resection were the most important clinical factors affecting PFS and OS, respectively. Anaplastic histology, mitotic count, and Ki-67 index can be used as universal and easily available prognostic parameters in infratentorial ependymomas.

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Acknowledgment

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (2008–0061821).

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea

    Ji Hoon Phi, Kyu-Chang Wang, Ji Yeoun Lee & Seung-Ki Kim

  2. Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea

    Sung-Hye Park

  3. Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea

    Il Han Kim

  4. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

    Il Han Kim & Hyo Seop Ahn

  5. Department of Diagnostic Radiology, Seoul National University Hospital, Seoul, Republic of Korea

    In-One Kim

  6. Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Republic of Korea

    Kyung Duk Park & Hyo Seop Ahn

  7. Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Republic of Korea

    Young-Je Son

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Phi, J.H., Wang, KC., Park, SH. et al. Pediatric infratentorial ependymoma: prognostic significance of anaplastic histology. J Neurooncol 106, 619–626 (2012). https://doi.org/10.1007/s11060-011-0699-x

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