Journal of Neuro-Oncology

, Volume 106, Issue 3, pp 619–626 | Cite as

Pediatric infratentorial ependymoma: prognostic significance of anaplastic histology

  • Ji Hoon Phi
  • Kyu-Chang Wang
  • Sung-Hye Park
  • Il Han Kim
  • In-One Kim
  • Kyung Duk Park
  • Hyo Seop Ahn
  • Ji Yeoun Lee
  • Young-Je Son
  • Seung-Ki KimEmail author
Clinical Study – Patient Study


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.


Ependymoma Children Prognosis Survival Anaplastic histology 



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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Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Ji Hoon Phi
    • 1
  • Kyu-Chang Wang
    • 1
  • Sung-Hye Park
    • 2
  • Il Han Kim
    • 3
    • 4
  • In-One Kim
    • 5
  • Kyung Duk Park
    • 6
  • Hyo Seop Ahn
    • 4
    • 6
  • Ji Yeoun Lee
    • 1
  • Young-Je Son
    • 7
  • Seung-Ki Kim
    • 1
    Email author
  1. 1.Division of Pediatric NeurosurgerySeoul National University Children’s HospitalSeoulRepublic of Korea
  2. 2.Department of PathologySeoul National University HospitalSeoulRepublic of Korea
  3. 3.Department of Radiation OncologySeoul National University HospitalSeoulRepublic of Korea
  4. 4.Cancer Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
  5. 5.Department of Diagnostic RadiologySeoul National University HospitalSeoulRepublic of Korea
  6. 6.Department of PediatricsSeoul National University Children’s HospitalSeoulRepublic of Korea
  7. 7.Department of NeurosurgerySeoul National University Boramae Medical CenterSeoulRepublic of Korea

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