PROGNOSTIC FACTORS IN CHILDHOOD INTRACRANIAL EPENDYMOMAS - THE ROLE OF AGE AND TUMOR LOCATION

Despite several clinical reports on intracranial ependymomas in childr en, the factors which affect prognosis, and the possibility that certa in combinations of factors might limit survival, are still a matter of debate. Between 1976 and 1996 we operated on 35 children with intracr anial ependymomas. Postoperative irradiation was given to 27 patients, with associated chemotherapy in 6 cases. Mean follow-up was 62 months . In 12 patients a 5-year follow-up was possible. In October 1996, 18 patients (51.4%) were still alive, the longest disease-free follow-up being 20 years, and the shortest 8 months. We analyzed the prognostic relevance of eight factors. For each factor, different subgroups were distinguished and compared as follows: age at diagnosis (<4 vs. greate r than or equal to 4 years), sex, tumor location (supratentorial vs. i nfratentorial), tumor size (<4 vs. 4-7 vs. >7 cm), surgical removal (t otal vs. subtotal), histology (low-grade vs. anaplastic), morphology ( solid vs, cystic), adjuvant therapies (treatment vs. no treatment). Tw o-way contingency tables were made to identify associations between va riables. The only significant association was between age and tumor lo cation (p = 0.022): in children under 4, tumors were almost invariably located in the posterior fossa (9 out of 10 cases) with a clear prefe rence for the lateral recess (8 cases). Other correlations were not si gnificant. Kaplan-Meier survival curves were compared to assess the pr ognostic relevance of each factor. Survival was significantly lower fo r children under 4, for those with posterior fossa tumors, and for pat ients with residual tumor (p < 0.05). A multivariate analysis compared variables which significantly affected survival, revealing that age i s the most important factor affecting prognosis (p < 0.05), while tumo r location and surgical removal do not add any significance to the eff ect of age on survival. We conclude that age has the strongest prognos tic relevance in childhood intracranial ependymomas, while the effect of tumor location on survival may be related to the high incidence of lateral recess ependymomas in younger children.