• Abhijit Goyal-Honavar, Ambritha Balasundaram, Immanuel Paul Thayakaran, Malavika Babu, Rekha Pai, Julie Joseph, Ranjani Jayachandran, Ari G Chacko, Leni G Mathew, Rajesh Balakrishnan, Vedantam Rajshekhar, L Jeyaseelan, Thambu David Sudarsanam, and Geeta Chacko.
• Department of Neurosurgery, Christian Medical College, Vellore, India.
• World Neurosurg. 2022 Aug 1; 164: e82-e90.

BackgroundSupratentorial ependymomas (STEs) are an aggressive group of ependymomas, topographically distinct from their posterior fossa and spinal counterparts. Zinc finger translocation associated (ZFTA) fusion-positive cases have been reported to account for the majority of STEs, although data on its association with poorer outcomes are inconsistent.Materials And MethodsWe assessed the prevalence of the ZFTA fusion by reverse-transcription polymerase chain reaction and fluorescence in situ hybridization in a cohort of 61 patients (68 samples) with STE. Our primary outcome was to determine the role of the ZFTA fusion on progression-free and overall survival of patients with STE. Our secondary objectives were to assess the impact of ZFTA fusion on nuclear factor (NF)-kB pathway signaling via surrogate markers of this pathway, namely COX-2, CCND1, and L1 cell adhesion molecule.ResultsZFTA fusion was noted in 21.3% of STEs in our cohort. The presence of this rearrangement did not significantly impact the progression-free or overall survival of patients with STEs and was not associated with upregulation of markers of the NF-kB pathway. Only gross total resection was significantly associated with better progression-free survival.ConclusionsIn contradiction to previous reports from across the world, the ZFTA fusion is far less prevalent among our population. It does not appear to drive NF-kB signaling or significantly affect outcomes. Gross total resection must be attempted in all cases of STE and adjuvant radiation and/or chemotherapy employed when gross total resection is not achieved.Copyright © 2022 Elsevier Inc. All rights reserved.

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