Adult ependymal tumors: prognosis and the M. D. Anderson Cancer Center experience

Ependymomas in adults are rare and often misdiag-nosed. This study reports on a series of adult patients with confirmed ependymoma treated at The University of Texas M. D. Anderson Cancer Center (MDACC). Patients aged>17 and with ependymoma were ident-ified, and clinical data were collected by retrospective chart review. Descriptive statistics were used to describe the clinical data, Kaplan–Meier methods were used to generate survival curves, and Cox proportional hazards models were used to evaluate the association of clinical characteristics with survival. This series included 123 adult patients [51 % male; median age 39 years (18–72)]. Forty had tumors in the brain, 80 in the spine, and 3 had both. The majority were Grade I/ II lesions (108) vs Grade III (anaplastic; 15). Eighteen patients had tumors that were reclassified as ependymal tumors at MDACC. The most common presenting symptom was pain, with an average of 4 symptoms reported prior to diagnosis. Sixty-three percent of patients had a gross total resection, and 49 % received radiation therapy. Average follow-up was 5.5 years, and 13 % had died. Median time to recurrence was 21 months (Grade II) brain and 18 months (Grade III). Worse outcome measured by overall and progression-free survival were associated with brain location (P 5.01, P5.04) and tumor anaplasia (P 5.0025, P 5.001). An MIB-1> 10 was associated with worse outcome (P5.03). Tumor grade and brain location are associated with a worse prognosis. Reclassification of ependymoma by neuropathologists is common. Results of this study have lead to a multicenter study to further define important diagnostic and prognostic variables for adults with ependymoma