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Vol. 4. Issue 2.
Pages 125-131 (January 1993)
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Vol. 4. Issue 2.
Pages 125-131 (January 1993)
Factores pronósticos en la evolución de los ependimomas intracraneales
J. Piquer, J. Cabanes, P. Riesgo, C. Botella, J. Navarro, M. Orozco, J. Alvarez Garijo
Hospital Universitario La Fe. Valencia
M. Hemández*, J.A. Ramos*
* Servicio de Neurocirugía; Servicio de Anatomía Patológica
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Resumen

Se analizan los factores pronósticos y supervivencia de 38 pacientes afectados de ependimomas intracraneales, que fueron intervenidos quirúrgicamente en el Hospital La Fe de Valencia durante el período 1969–1990. La edad media fue de 12 años (rango, 1–59 años). Se practicó resección total de la lesión en 17 pacientes, subtotal en 20 y parcial en uno. La histología tumoral fue revisada en cada caso y se agrupó en ependimomas de bajo (58%) y alto grado de malignidad (42%). En 16 pacientes se administró radioterapia complementaria (dosis media 4900 cGy). El tiempo medio de seguimiento se aproximó a los 49 meses, siendo la probabilidad de supervivencia a los 5 años del 58% tras excluir la mortalidad operatoria. Los factores que se asociaron con una supervivencia más favorable fueron: extirpación radical, histología de bajo grado, radioterapia complementaria y ausencia de signos de invasión de tronco o pares craneales. Por el contrario, la supervivencia fue menor en aquellos casos con signos de invasión de tronco o pares craneales, extirpación subtotal o parcial, histología de alto grado y desestimación de radioterapia complementaria. El grado histológico de la neoplasia fue la única variable con valor pronóstico estadísticamente significativo (p<0,05).

Palabras clave:
Ependimoma
pronóstico
supervivencia postoperatoria
neoplasia cerebral
Summary

The prognostic factors and survival data were analyzed for 38 patients with intracranial ependymoma treated surgically at the Hospital La Fe in Valencia during the years 1969 to 1990. The median age was 12 years (range, 1–59 yr). Gross total resection was performed in 17 patients, subtotal in 20 and partial in only 1 case. Tumor histology was reviewed individually and grouped into low grade (58%) and high grade (42%). Sixteen patients underwent radiotherapy (median dose 4900 cGy). With a median follow-up of 49 monts, the actuarial survival rates at 5 years were 58% after the exclusion of perioperative mortality. Factors associated with an improved 5-year survival rate were: total tumor removal, low grade histology, radiation therapy and absent brain-stem o cranial nerve signs in infratentorial cases. The 5-year survival rate was lower when associated with presence of physical signs of parenchymal invasion or lower cranial nerve involvement in infratentorial tumors, subtotal tumor removal, high grade histology and no radiotherapy treatment. The tumor's histological grade was the onIy prognostic variable with significant difference (p<0,05).

Key words:
Ependymoma
prognosis
postoperative survival
brain neoplasm

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