• Abdel-Hameed Al-Mistarehi, Megan Parker, Yuanxuan Xia, Alireza Hasanzadeh, HorowitzMelanie AlfonzoMADepartment of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Divyaansh Raj, Pritika Papali, A Daniel Davidar, Kristin J Redmond, Chetan Bettegowda, Timothy Witham, Ali Bydon, Nicholas Theodore, and Daniel Lubelski.
• Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
• World Neurosurg. 2024 Oct 1; 190: e920e930e920-e930.

BackgroundUsing a multi-institutional oncology database, we investigate the survival rates and the impacts of demographic, clinical, and management characteristics on overall survival among adult patients diagnosed with spinal ependymoma.MethodsUtilizing the SEER registry, patients with histologically or radiologically confirmed ependymomas were included. Factors impacting overall survival were analyzed using Kaplan-Meier survival curves and log-rank statistical analyses.ResultsA total of 1,580 patients were included. Their mean ± standard deviation age was 46.68 ± 15.96 years, and 51.1% were women. Gross total resection (GTR) was achieved in 66.4% of patients. The 5- and 10-year survival rates were 96.7% and 95.4%, respectively. A multivariable backward Cox regression showed that age ≥65 years was a significant predictor for mortality (hazard ratio [HR]: 3.93; 95% confidence interval [CI]: 2.21-7.00; P < 0.001). Likewise, tumor grade 3 (HR: 6.36; 95% CI: 1.95-20.76; P = 0.002), tumor grade 4 (HR: 7.74; 95% CI: 3.97-15.11; P < 0.001), presence of extra-neural metastasis (HR: 13.81; 95% CI: 3.67-51.96; P < 0.001), and receiving radiotherapy (HR: 2.50; 95% CI: 1.50-4.19; P < 0.001) were significant risk factors for mortality, while GTR was significantly associated with improved overall survival compared with subtotal resection or nonsurgical management (HR: 0.42; 95% CI: 0.25-0.73; P = 0.002). There were no significant effects for gender, race, marital status, income, residential area, chemotherapy, tumor size, and the presence of other benign or malignant tumors on the survival hazards (P > 0.05 for each).ConclusionEarly diagnosis and surgical management of spinal ependymomas, such as GTR, were associated with remarkable survival benefits. Old age, high-grade spinal ependymoma, and extra-neural metastasis were associated with worse overall survival, whereas radiotherapy's role remains unclear.Copyright © 2024 Elsevier Inc. All rights reserved.

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