E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Clinicopathologic and Molecular Signatures Driving Risk Stratification in Posterior Fossa Ependymoma
Digvijay Singh Thakur✉ ,
Manish Beniwal ,
Nandeesh BN ,
Dwarakanath Srinivas ,
Gaurav Tyagi ,
Aparna Sharma
Aparna Sharma
Anatomy, Shree Guru Gobind Singh Tricentenary University
DOI: 10.5137/1019-5149.JTN.50843-26.2
Accepted: 18/09/2026
Article in Press
Corresponding Author:
Digvijay Singh Thakur (diguthakur@gmail.com)
Abstract
Aim
Posterior fossa ependymomas (PFE) are biologically heterogeneous tumors with variable outcomes. This study aimed to correlate molecular alterations1q gain, 6q loss, H3K27me3 status, and Tenascin-C expressionwith clinical outcomes, and to perform a comprehensive multiseries (multivariate) survival analysis to determine independent prognostic factors.
Material and Methods
A retrospective analysis was conducted on 38 patients with histologically confirmed PFE treated between 20152019. Molecular profiling was performed using fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC). Clinical, radiological, and histopathological data were collected. KaplanMeier and Cox multivariate regression analyses were performed for progression-free survival (PFS) and overall survival (OS). Variables included 1q gain, 6q loss, H3K27me3 loss, Tenascin-C overexpression, extent of resection, and adjuvant therapy.
Results
The mean follow-up duration was 3.5 years. 1q gain was found in 36.8%, 6q loss in 15.8%, TNC overexpression in 57.9%, and H3K27me3 loss in 52.6%. KaplanMeier analysis showed significantly poorer OS with 1q gain (p=0.04), 6q loss (p=0.002), and high TNC expression (p=0.046). Multivarieate Cox regression revealed that 1q gain (HR 2.64, p=0.03), 6q loss (HR 2.88, p=0.02), and high TNC (≥2+) (HR 2.42, p=0.04) were independent predictors of poor OS. Radiotherapy was associated with improved PFS (p=0.004), while H3K27me3 status was not significantly related to outcome.
Conclusion
Combined molecular aberrations1q gain, 6q loss, and Tenascin-C overexpressionrepresent independent prognostic markers in PFE. Multiseries (multivariate) survival analysis provides a refined model for risk stratification and can aid in tailoring treatment intensity for individual patients.
Posterior fossa ependymomas (PFE) are biologically heterogeneous tumors with variable outcomes. This study aimed to correlate molecular alterations1q gain, 6q loss, H3K27me3 status, and Tenascin-C expressionwith clinical outcomes, and to perform a comprehensive multiseries (multivariate) survival analysis to determine independent prognostic factors.
Material and Methods
A retrospective analysis was conducted on 38 patients with histologically confirmed PFE treated between 20152019. Molecular profiling was performed using fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC). Clinical, radiological, and histopathological data were collected. KaplanMeier and Cox multivariate regression analyses were performed for progression-free survival (PFS) and overall survival (OS). Variables included 1q gain, 6q loss, H3K27me3 loss, Tenascin-C overexpression, extent of resection, and adjuvant therapy.
Results
The mean follow-up duration was 3.5 years. 1q gain was found in 36.8%, 6q loss in 15.8%, TNC overexpression in 57.9%, and H3K27me3 loss in 52.6%. KaplanMeier analysis showed significantly poorer OS with 1q gain (p=0.04), 6q loss (p=0.002), and high TNC expression (p=0.046). Multivarieate Cox regression revealed that 1q gain (HR 2.64, p=0.03), 6q loss (HR 2.88, p=0.02), and high TNC (≥2+) (HR 2.42, p=0.04) were independent predictors of poor OS. Radiotherapy was associated with improved PFS (p=0.004), while H3K27me3 status was not significantly related to outcome.
Conclusion
Combined molecular aberrations1q gain, 6q loss, and Tenascin-C overexpressionrepresent independent prognostic markers in PFE. Multiseries (multivariate) survival analysis provides a refined model for risk stratification and can aid in tailoring treatment intensity for individual patients.
Keywords
Posterior fossa ependymoma
Tenascin-C
H3K27me3
Multivariate analysis
Cox regression