OBJECTIVE: Ependymomas arise from different areas in the neuraxis and have
variable outcomes that depend on tumor location and patient age at the time
of presentation. The predictive value of histology for these tumors is unr
esolved. We report a series of adult patients with supratentorial ependymom
as to characterize the roles of surgery, histology, ploidy, and proliferati
on index in tumor control.
METHODS: Fourteen of the 23 supratentorial ependymomas were in the region o
f the third ventricle and the remainder were located in the hemispheres. Re
sections were gross total in 12 patients, subtotal in 8, and biopsy in 3. A
single pathologist reviewed all slides and quantitated the deoxyribonuclei
c acid. The mean follow-up duration was 95 months (+/-75 mo).
RESULTS: All of the malignant ependymomas were hemispheric (n = 4). Mortali
ty occurred only in patients with third ventricular tumors; two patients di
ed as a result of surgical complications and three as a result of tumor pro
gression. Kaplan-Meier estimates of 5- and 10-year survival rates were 100%
for hemispheric and 72.5% for third ventricular tumors (62.5% including th
e two perioperative deaths). The median time to recurrence was 53 months, w
ith a 10-year progression-free survival rate of 27%. Univariate analysis re
vealed that recurrence was associated with malignant histology, including m
itoses, cellularity, and aneuploidy. For nonmalignant ependymomas, recurren
ce was associated with subtotal resection and metastases. S-phase fraction
did not correlate with recurrence. Only malignant histology correlated with
recurrence on multivariate analysis.
CONCLUSION: Although the numbers are too small to draw any definite conclus
ions, treatment of ependymomas that arise in the supratentorial compartment
in adult patients results in excellent outcomes despite frequent recurrenc
es. Association with the third ventricle and metastases seem to have a nega
tive impact on survival, whereas malignant histology, subtotal resection, a
nd metastases may be predictors of recurrence.