Predictors of Progression-Free Survival in Patients With Spinal Intramedullary Ependymoma: A Multicenter Retrospective Study by the Neurospinal Society of Japan

PRO-QOL after gross total resection of spinal ependymoma: a retrospective study based on 3-year follow-up observations in a single center

BACKGROUND

Although many studies have reported clinical outcomes of spinal ependymoma (SE) patients after gross total resection (GTR), the data about the patient reported outcomes of the quality of life (PRO-QOL) was limited.

PURPOSE

This study investigated the recovery process of PRO-QOL and explored the possibility of predicting the recovery of postoperative QOL by preoperative clinical indicators.

METHODS

A retrospective analysis was performed in 71 SE patients who underwent GTR in our center from 2016 to 2022. The PRO-QOL data were collected by questionnaire, which included the EuroQol 5-Dimensions 5-Levels (EQ-5D-5 L) scale and visual pain analogue score (VAS). Factors affecting postoperative PRO-QOL deterioration was assessed by the univariate and multivariate analyses.

RESULTS

71 SE patients who undergone GTR were included and followed by mean of 36 months (range 27-58). The overall PRO-QOL recovered to a stable level 6 months after surgery, but the ability of self-care, as one of the dimensions of QOL, continued to improve up to one year after surgery. 21 (29.6%) patients reported that their QOL became worse at one year after surgery. The result of statistical analysis suggested that preoperative Modified McCormick Scale (MMS), the number of segments involved by the tumor and preoperative VAS score were identified as main preoperative variables for predicting QOL deterioration.

CONCLUSION

From the perspective of PRO-QOL, neurological rehabilitation should be continued for at least 6-12 months after GTR to the SE patients. For the preoperative patients with severe neurological damage, long-level intraspinal tumor and low VAS score, more cautious surgical considerations, more perioperative attention and earlier neurological intervention are necessary.

Clinical presentation and extent of resection impacts progression-free survival in spinal ependymomas

PURPOSE

Primary treatment of spinal ependymomas involves surgical resection, however recurrence ranges between 50 and 70%. While the association of survival outcomes with lesion extent of resection (EOR) has been studied, existing analyses are limited by small samples and archaic data resulting in an inhomogeneous population. We investigated the relationship between EOR and survival outcomes, chiefly overall survival (OS) and progression-free survival (PFS), in a large contemporary cohort of spinal ependymoma patients.

METHODS

Adult patients diagnosed with a spinal ependymoma from 2006 to 2021 were identified from an institutional registry. Patients undergoing primary surgical resection at our institution, ≥ 1 routine follow-up MRI, and pathologic diagnosis of ependymoma were included. Records were reviewed for demographic information, EOR, lesion characteristics, and pre-/post-operative neurologic symptoms. EOR was divided into 2 classifications: gross total resection (GTR) and subtotal resection (STR). Log-rank test was used to compare OS and PFS between patient groups.

RESULTS

Sixty-nine patients satisfied inclusion criteria, with 79.7% benefitting from GTR. The population was 56.2% male with average age of 45.7 years, and median follow-up duration of 58 months. Cox multivariate model demonstrated significant improvement in PFS when a GTR was attained (p <.001). Independently ambulatory patients prior to surgery had superior PFS (p <.001) and OS (p =.05). In univariate analyses, patients with a syrinx had improved PFS (p =.03) and were more likely to benefit from GTR (p =.01). Alternatively, OS was not affected by EOR (p =.78).

CONCLUSIONS

In this large, contemporary series of adult spinal ependymoma patients, we demonstrated improvements in PFS when GTR was achieved.

Surgical Outcomes and Medical Costs Associated with Spinal Cord Tumors: Comparison of Extramedullary and Intramedullary Tumors

OBJECTIVE

This study aimed to clarify the differences in the perioperative data of patients with extramedullary and intramedullary tumors and estimate the impact of surgery on medical costs.

METHODS

This single-center retrospective study included consecutive patients who underwent spinal tumor resection between September 2020 and December 2022. The perioperative medical information and medical costs for individual patients were obtained from their medical records.

RESULTS

Thirty-two patients with extramedullary spinal cord tumors and 18 with intramedullary spinal cord tumors were included in the study. The 2 groups had no difference in surgery-related or major systemic complications. However, the operation time and the length of hospital stay were significantly longer and activities of daily living at discharge tended to worsen in the intramedullary tumor group compared to those in the extramedullary tumor group. As a result, the discharge outcome was significantly different between the 2 groups. The total medical costs for intramedullary tumors were approximately 1.43 times higher than those for extramedullary tumors. Further, a better functional outcome at discharge can save medical costs, regardless of extramedullary or intramedullary tumors.

CONCLUSIONS

Surgery for intramedullary tumors can be performed with similar perioperative risks as for extramedullary tumors. However, intramedullary tumors are associated with concerns, such as prolonged hospitalization and worsening of activities of daily living at discharge, which ultimately result in higher medical costs.