BACKGROUND Treatment of ependymoma (EPN) is guided by associated tumor features, such as grade and location. However, the relationship between these features with treatments and overall survival in EPN patients remains uncharacterized. Here, we describe the change over time in treatment strategies and identify tumor characteristics that influence treatment and survival in EPN. METHODS AND MATERIALS Using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 18 Registries (1973-2016) database, we identified patients with EPN microscopically confirmed to be grade II (EPN-GII) or III (EPN-GIII) tumors between 2004-2016. Overall survival (OS) was analyzed using Kaplan-Meier survival estimates and multivariable Cox proportional hazard models. A sub-analysis was performed by tumor location (supratentorial, posterior fossa, and spine). Change over time in rates of gross total resection (GTR), radiotherapy (RT), and chemotherapy (CS) were analyzed using linear regression, and predictors of treatment were identified using multivariable logistic regression models. RESULTS Between 2004-2016, 1,671 patients were diagnosed with EPN, of which 1,234 (74 %) were EPN-GII and 437 (26 %) EPN-GIII. Over the study period, EPN-GII patients underwent a less aggressive treatment (48 % vs 27 %, GTR; 60 % vs 30 %, RT; 22 % vs 2%, CS; 2004 vs 2016; p < 0.01 for all). Age, tumor size, location, and grade were positive predictors of undergoing treatment. Univariate analysis revealed that tumor grade and location were significantly associated with OS (p < 0.0001 for both). In multivariable Cox regression, tumor grade was an independent predictor of OS among patients in the cohort (grade III, HR 3.89 [2.84-5.33]; p < 0.0001), with this finding remaining significant across all tumor locations. CONCLUSIONS In EPN, tumor grade and location are predictors of treatment and overall survival. These findings support the importance of histologic WHO grade and location in the decision-making for treatment and their role in individualizing treatment for different patient populations.

中文翻译：

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II/III 级室管膜瘤患者的治疗趋势和总生存期：肿瘤分级和位置的作用

背景室管膜瘤 (EPN) 的治疗由相关的肿瘤特征指导，例如分级和位置。然而，这些特征与 EPN 患者的治疗和总生存之间的关系仍未得到表征。在这里，我们描述了治疗策略随时间的变化，并确定了影响 EPN 治疗和生存的肿瘤特征。方法和材料 使用美国国家癌症研究所的监测、流行病学和最终结果 (SEER) 18 登记 (1973-2016) 数据库，我们确定了经显微镜证实为 II 级 (EPN-GII) 或 III (EPN-GIII) 的 EPN 患者2004-2016 年间的肿瘤。使用 Kaplan-Meier 生存估计和多变量 Cox 比例风险模型分析总生存 (OS)。亚组分析按肿瘤位置（幕上、后颅窝和脊柱）。使用线性回归分析总切除率 (GTR)、放疗 (RT) 和化疗 (CS) 率随时间的变化，并使用多变量逻辑回归模型确定治疗预测因子。结果 2004-2016 年间，1,671 名患者被诊断为 EPN，其中 1,234 (74%) 名患者为 EPN-GII，437 (26%) 名患者为 EPN-GIII。在研究期间，EPN-GII 患者接受了不太积极的治疗（48 % 对 27 %，GTR；60 % 对 30 %，RT；22 % 对 2%，CS；2004 年对 2016 年；所有 p < 0.01）。年龄、肿瘤大小、位置和分级是接受治疗的阳性预测因素。单变量分析显示肿瘤等级和位置与 OS 显着相关（两者 p < 0.0001）。在多变量 Cox 回归中，肿瘤分级是队列中患者 OS 的独立预测因子（III 级，HR 3.89 [2.84-5.33]；p < 0.0001），这一发现在所有肿瘤位置上仍然显着。结论 在 EPN 中，肿瘤分级和位置是治疗和总生存期的预测因素。这些发现支持组织学 WHO 分级和位置在治疗决策中的重要性及其在不同患者人群个体化治疗中的作用。