Objective

Microsurgical resection of spinal ependymomas is associated with a considerable risk of postoperative neurological deterioration. We aimed to develop a risk score for outcome prediction after surgery for spinal ependymoma.

Materials and methods

All patients who underwent microsurgical resection of spinal ependymoma between 1980 and 2015 were included. Different perioperative parameters were collected for the score construction. Poor outcome was defined as the modified McCormick Scale (MMCS) >2 at 6 months after surgery.

Results

Of 131 patients (mean age: 45.6 ± 16.7 years; 63 females), 38 cases (29%) showed poor outcome. Based on the univariate analysis, preoperative MMCS, subtotal tumor resection, proximal tumor level on the spinal cord, tumor extension, intramedullary location, and WHO grading were included in the multivariate analysis. The final risk score consisted of the following independent predictors: preoperative MMCS > 1 (1 point), proximal tumor level at Th 10 and higher (1 point), and tumor extension ≥ 3 vertebrae (1 point). The constructed score (0–3 points; Score for OUtcome after Resection of Spinal Ependymoma [SOURSE]) showed high diagnostic accuracy (area under the curve [AUC] = 0.883), which was superior to preoperative MMCS (AUC = 0.798) and Karnofsky Performance Status (AUC = 0.794). Patients scoring 0, 1, 2, and 3 points showed poor outcome in 0%, 12.9%, 54.6%, and 76.2% of the cases respectively.

Conclusion

The presented SOURSE score based on preoperative neurologic condition, tumor location, and tumor extension could accurately predict the postoperative outcome in patients undergoing microsurgery of spinal ependymoma. Our data should be validated in a prospective trial.

中文翻译：

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脊柱室管膜瘤显微切除术后预后预测的风险评分（SOURSE 评分）

客观的

脊柱室管膜瘤的显微手术切除与术后神经功能恶化的相当大的风险相关。我们旨在为脊柱室管膜瘤手术后的结果预测制定风险评分。

材料和方法

纳入了 1980 年至 2015 年间接受显微手术切除脊柱室管膜瘤的所有患者。为评分构建收集了不同的围手术期参数。不良结局定义为术后 6 个月改良的 McCormick 量表（MMCS）>2。

结果

在 131 名患者（平均年龄：45.6 ± 16.7 岁；63 名女性）中，38 例（29%）结果不佳。基于单因素分析，多因素分析包括术前MMCS、肿瘤次全切除、脊髓近端肿瘤水平、肿瘤扩展、髓内位置和WHO分级。最终风险评分由以下独立预测因子组成：术前 MMCS > 1（1 分），近端肿瘤水平在 Th 10 或更高（1 分），肿瘤延伸≥ 3 个椎骨（1 分）。构建的分数（0-3 分；OU的S核心是在脊髓E室管膜瘤切除后[ SOURSE]）显示出较高的诊断准确性（曲线下面积 [AUC] = 0.883），优于术前 MMCS（AUC = 0.798）和 Karnofsky 体能状态（AUC = 0.794）。得分为 0、1、2 和 3 分的患者分别有 0%、12.9%、54.6% 和 76.2% 的病例出现不良预后。

结论

基于术前神经系统状况、肿瘤位置和肿瘤扩展的 SOURSE 评分可以准确预测接受脊柱室管膜瘤显微手术的患者的术后结果。我们的数据应在前瞻性试验中得到验证。