# Outcomes and Pattern of Care for Spinal Myxopapillary Ependymoma in the Modern Era—A Population-Based Observational Study

## TL;DR

This study analyzes outcomes and treatment patterns for spinal myxopapillary ependymoma, finding that surgery improves survival and male sex is linked to worse outcomes.

## Contribution

The study is the largest of its kind, revealing sex-specific survival differences and emphasizing surgery's role in treating spinal MPE.

## Key findings

- Younger age and undergoing surgery were associated with improved survival in spinal MPE patients.
- Male sex was unexpectedly linked to worse survival and earlier diagnosis compared to females.
- The 10-year overall survival rate for spinal MPE patients was estimated at 91.4%.

## Abstract

Myxopapillary ependymoma (MPE) is a rare tumor that typically grows in the lower spine. It is usually not aggressive and is most effectively treated with surgery. We studied data from over a thousand patients with spinal MPE from 2000 to 2020. Surgery was the main treatment for almost all patients. We found that younger age and having surgery were linked to better survival. Surprisingly, being male was associated with worse survival, and they tended to be diagnosed at a younger age than females. Our study, the largest of its kind, provides important information for treating spinal MPE.

(1) Background: Myxopapillary ependymoma (MPE) is a rare tumor of the spine, typically slow-growing and low-grade. Optimal management strategies remain unclear due to limited evidence given the low incidence of the disease. (2) Methods: We analyzed data from 1197 patients with spinal MPE from the Surveillance, Epidemiology, and End Results (SEER) database (2000–2020). Patient demographics, treatment modalities, and survival outcomes were examined using statistical analyses. (3) Results: Most patients were White (89.9%) with a median age at diagnosis of 42 years. Surgical resection was performed in 95% of cases. The estimated 10-year overall survival was 91.4%. Younger age (hazard ratio (HR) = 1.09, p < 0.001) and receipt of surgery (HR = 0.43, p = 0.007) were associated with improved survival. Surprisingly, male sex was associated with worse survival (HR = 1.86, p = 0.008) and a younger age at diagnosis compared to females. (4) Conclusions: This study, the largest of its kind, underscores the importance of surgical resection in managing spinal MPE. The unexpected association between male sex and worse survival warrants further investigation into potential sex-specific pathophysiological factors influencing prognosis. Despite limitations, our findings contribute valuable insights for guiding clinical management strategies for spinal MPE.