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TABLE I. Patient Characteristics, n ¼ 635 Characteristic n

RESULTS

The characteristics of the 635 patients identified from the SEER database are listed in Table I. Most tumors, 80.5%, were classified as well-differentiated, or unspecified, ependymoma (9391) while the remaining included anaplastic, papillary and myxopapillary ependymomas. Mean age was 6.3 standard error 0.22 years and median age 4 years. Overall, a majority of patients were male and the predominant racewas white. Most patients (56.4%) were reported to have received radiotherapy. The most common identified tumor location was infratentorial. Univariate comparisons of survival based upon age, race, gender, and treatment appear in Table II. Radiotherapy was associated with significantly increased survival compared with no treatment (logrank P ¼ 0.022). There was no significant difference in survival by gender or race, although there were trends toward improved survival among females compared with males and whites compared with blacks. Increasing age was associated with improved survival (logrank P < 0.0001). Tumor location was classified into spinal, supratentorial, and infratentorial according to Figure 1. Three hundred fifty-four tumors were included in the location analysis. Univariate analysis demonstrated a significant difference in survival among the three tumor locations, with improved survival among spinal tumors (logrank P ¼ 0.001; Fig. 2). There was no difference in 5-year survival between supratentorial and infratentorial locations. Spe- cific 5-year survival data for the three locations appear in Table III. Even when survival analyses for location were repeated by including the indeterminate location cases with classification as all supratentorial or all infratentorial, our findings were unchanged (data not shown). Radiotherapy for the individual tumor locations was also compared (Table IV). Using univariate analysis, radiotherapy did not significantly affect survival in spinal or supratentorial tumors. Radiotherapy appeared to convey a significant survival improve- ment for infratentorial tumors compared to no treatment in both univariate analysis (logrank P ¼ 0.018, Fig. 3) and subgroup multivariate analysis restricted to infratentorial tumors ( P ¼ 0.033). Using multivariate analysis for all tumor locations,

%

Gender Male

370 265

58.3 41.7

Female

Age at initial diagnosis, years 0–4

329 104

51.8 16.4 12.6 10.5

5–8

9–12

80 67 55

13–15 16–18

8.6

Mean standard deviation

6.33 5.45

Median

4

Histologic diagnosis (ICD-0-3 code) Ependymoma (9391) Anaplastic ependymoma (9392) Papillary ependymoma (9393) Myxopapillary ependymoma (9394)

511 119

80.5 18.7

1

0.2 0.6

4

Primary tumor site Supratentorial

106 193

16.7 30.4

Infratentorial

Spinal Other

55

8.7

281

44.3

Race

White Black Other

510

80.3 12.1

77 48

7.5

Treatment

Radiotherapy

358 254

56.4 40.0

No radiotherapy

Unknown

23

3.6

n, number of children.

radiotherapy. Hazard ratios and 95% confidence intervals were calculated. An interaction term was created for location and age in order to test for effect modification between the two independent variables. All statistical analyses were completed using SPSS (version 15.0, Chicago, IL).

TABLE II. Univariate Comparison of Survival by Gender, Race, and Treatment

Median survival (months)

n

5-year survival (%)

SE (%)

P -value*

Gender

0.97

Male

370 265

97.0 154

56.4 54.9

3.0 3.6

Female

Race

0.20

White Black

510

154 53.0

56.7 45.1

2.5 6.7

77

Treatment

0.022

Radiotherapy

358 254

154 91.0

56.8 53.6

3.0 3.6

No radiotherapy

Age

< 0.0001

0–4 5–8

329 104

43.0 145 268

45.5 56.5 63.3 75.8 77.0

3.1 6.1 6.5 6.1 7.0

9–12

80 67 55

13–15 16–18

— —

n, number of children; SE, standard error. *Logrank Test.

Pediatr Blood Cancer DOI 10.1002/pbc