Ependymal Tumours: The Clinical And Pathological Features And The Diagnosis Of Prognostic Factors In 54 Cases

Objective.To evaluate the current management strategies of patients with an ependymoma and to explore the prognostic factors, which have a significant association with the outcome,can efficiently provide the reference recommendations for the clinical management.Methods:The medical data of 54 cases with ependymoma,which were admited to the neurosurgical group of Prof Yuan in Xiangya hospital between 1990 and 2007.Details regarding clinical presentation,imaging characteristics,histological stages,treatment,recurrence and survival time.The Kaplan-Meier method,Log-rank test,Chi-square test and Fisher exact probabilities test were used to analyze the prognostic factor,which can offer the reference for our clinical treatment.Results:The mean age was 32.33±14.15 years(range 3-63 years). 11 patients were dead in these cases,4 of them were dead in perioperative date,and the others were dead of the relapse of tumors in the same place. 20 were supratentorial(mean age 33.00±2.98 years),18 were infratentorial(mean age 25.42±3.11years),and 16 were spinal cord ependymomas(mean age 39.75±3.21 years).There were 6 children included in the cases and the other 48 cases were all adults.39(72.2%) patients had low grade(WHOⅠ—Ⅱ)and 15(27.8%)patients were high-grade(WHOⅢ)tumors.In the group of supratentorial cases,14 patients were low grade,6 cases were high grade.In the infratentorial group the number is 11 and 7 respectively,and in the spinal cord,the patients were 14 and 2.44(81.48%)patients had gross total resection and 10(18.51%)patients had subtotal resection.19 patients had radiotherapy after surgery and 2 patients had chemotherapy.The survival time rate of 3 years in the intracal patients is 87.87%,while the 5 years is 72.37%. Meanwhile,the rate of 5 years in spinal ependymomas is 100%.In the prognostic factors,age(x~2=6.03,P=0.0141＜0.05),histopathologic grading of the tumors(x~2=5.789,P=0.016＜0.05)and extent of resection(x~2=5.957,P=0.015＜0.05)can affect the survival time of intracal patients,the extent of resection(x~2=19.85,P=0.0002＜0.05) is the major factor of the gross survival time.Histopathologic grading of the tumors(x~2=4.727,P=0.004＜0.05)and extent of resection(x~2= 24.71,P=0.0001＜0.05)can affect the recurrence rate of the tumor.Conclusion:The progreesion of tomor is the recurrence in the same place.In the intracranial ependymomas,age,histopathologic grading and extent of resection are the important factors affecting survival time ratio. The extent of resection is the major factor affecting the survival time of the epedymal patients.Radiotherapy may improve the survival time of infratentorial patients with gross total resection.