Predictors of survival among older adults with ependymoma

Abstract

The biological process of aging encompasses a multitude of complex physiological and lifestyle changes that may alter the way typical prognostic factors affect survival among older ependymoma patients. Because very little is known about the clinical significance of traditional prognostic factors and the magnitude of their effects among older individuals, the purpose of this study was to evaluate the associations between survival and demographic and tumor characteristics among patients with ependymoma who were 60 years of age or older. Using the 1973-2007 dataset from the Surveillance, Epidemiology and End Results (SEER) program, we evaluated the impact of several factors on both overall and ependymoma-specific survival, utilizing multivariable Cox proportional hazards regression. We identified 367 ependymoma cases who were 60 years of age or older at diagnosis and had complete data from SEER. Of these, 19 (5.2%) had anaplastic tumors; all others were low-grade tumors. Age, tumor site, extent of surgery, and tumor histology were found to be significant predictors of ependymoma prognosis. The strongest predictor of poor outcome was supratentorial tumor location (adjusted HR: 6.94, 95% CI: 3.19-15.08, compared to spinal cord tumors). Our study suggests that tumor location, tumor histology, and surgical margin may be key predictors of survival among older ependymoma patients. We believe our study is one of the first to assess the prognostic value of these factors for ependymoma survival exclusively in an older patient population.

Fig. 1

Cause-specific Kaplan-Meier survival curves by ependymoma site. Among ependymoma patients over the age of 60, those with spinal cord tumors have consistently higher survival probabilities over time, compared to those who have tumors in the supratentorial region (p<0.001)

Fig. 2

Cause-specific Kaplan-Meier survival curves by ependymoma histology. Patients over the age of 60 with low-grade tumors have consistently better ependymoma survival over time compared to those with anaplastic tumors (p<0.001)

Fig. 3

Cause-specific Kaplan-Meier survival curves by surgical margin. Patients over the age of 60 who undergo gross total (or radical) resection have better ependymoma survival over time than those who undergo incomplete resections (p=0.001)