High failure rate in spinal ependymomas with long-term follow-up
High failure rate in spinal ependymomas with long-term follow-up
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DOI：
10.1215/s1152851704001231
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发表时间：
2005-07-01
期刊：
影响因子：
15.9
通讯作者：
Haas-Kogan, DA
中科院分区：
文献类型：
--
作者：
Gomez, DR;Missett, BT;Haas-Kogan, DA
关于脊髓室管膜瘤的数据很少，预后因素仍然存在争议。本研究的主要目的是回顾历史队列，该队列包含大量患者和长期随访，并提供进展时间 (TTP) 和进展后生存的估计。作为次要目标，我们评估潜在预后变量的影响。 1955年至2001年，37名脊髓室管膜瘤患者接受了术后放射治疗。使用Cox比例风险模型在单变量分析中评估了放射剂量、切除范围、卡诺夫斯基评分、肿瘤位置和多灶性的影响。未失败患者的中位随访时间为 121 个月（范围：8-312 个月）。 Kaplan-Meier 估计的 5 年、10 年和 15 年无进展百分比分别为 75% +/- 7.4%、50% +/- 9.1% 和 46% +/- 9.3%。对于那些复发的患者，中位 TTP 为 68 个月（范围为 2-324 个月），其中 21 次失败中有 12 次发生在五年后。预后与较长的 TTP 相关（P = 0.02）。脊髓室管膜瘤的局部复发率比之前提到的要高，其中很大一部分失败发生在诊断后五年以上。广泛的手术切除与较长的复发时间相关，因此我们建议最大程度的切除，同时避免手术并发症。总体复发率较高，因此我们建议对所有未进行总体切除和长期密切随访的患者进行 45 至 54 Gy 剂量的放射治疗。
Data on spinal ependymomas are sparse, and prognostic factors remain controversial. The primary aim of this study is to review a historical cohort, with large patient numbers and long follow-up, and provide estimates of time to progression (TTP) and survival after progression. As a secondary aim, we assess the effects of potential prognostic variables. Thirty-seven patients with spinal cord ependymomas received postoperative radiation therapy from 1955 to 2001. The influences of radiation dose, extent of resection, Karnofsky performance score, tumor location, and multifocality were assessed in univariate analyses by using the Cox proportional hazards model. The median follow-up for patients who did not fail was 121 months (range, 8-312 months). Kaplan-Meier estimates of 5-, 10-, and 15-year percentage progression free are 75% +/- 7.4%, 50% +/- 9.1%, and 46% +/- 9.3%, respectively. Median TTP, for those who recurred, is 68 months (range, 2-324 months), with 12 of 21 failures occurring after five years. Of the prognostic correlated with longer TTP (P = 0.02). Local relapse rates for spinal ependymomas are higher than previously cited, with a large proportion of failures occurring more than five years after diagnosis. Extensive surgical resection correlates with longer time to recurrence, and we thus recommend maximal excision while avoiding surgical morbidity. The overall high rate of recurrence leads us to recommend radiation to doses of 45 to 54 Gy for all patients who do not have gross total resections, and long, close follow-up.