Premium
Prognostic implication of clinical, radiologic, and pathologic features in patients with anaplastic gliomas
Author(s) -
Tortosa Avelina,
Viñolas Núria,
Villà Salvador,
Verger Eugènia,
Gil Juan M.,
Brell Marta,
Caral Lluís,
Pujol Teresa,
Acebes Juan J.,
Ribalta Teresa,
Ferrer Isidre,
Graus Francesc
Publication year - 2003
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.11120
Subject(s) - medicine , pathology , anaplastic astrocytoma , glioma , radiology , astrocytoma , cancer research
BACKGROUND The clinical evolution of anaplastic glioma (anaplastic astrocytoma, oligodendroglioma, and oligoastrocytoma) is variable. Previous studies merged patients with anaplastic glioma and the much more common glioblastoma multiforme. Therefore, the conclusions on prognostic factors reflected in part the consequences of an analysis in a heterogeneous population. METHODS To identify clinical, neuroradiologic, pathologic, and molecular factors with prognostic significance, we analyzed 95 treated patients with a histologic diagnosis of anaplastic glioma. Variables included age, gender, clinical manifestations at diagnosis (seizures, focal neurologic deficit, and cognitive changes), computed tomographic (CT) scan characteristics (diffuse, ring, and no enhancement), tumor location, extent of resection, histopathology, postoperative Karnofsky performance status (KPS) score, adjuvant chemotherapy, tumor response, proliferation index (Ki‐67 expression), and p53, p16, pRb, and epidermal growth factor receptor immunohistochemical expression. RESULTS Ninety‐five patients with a histologic diagnosis of anaplastic astrocytoma (73%), anaplastic oligoastrocytoma (16.6%), or anaplastic oligodendroglioma (10.4%) constituted the basis of this study. Median overall survival was 29 months. Multivariate analysis revealed that an age of 49 years or younger ( P < 0.03), postoperative KPS score of 80 or higher ( P < 0.007), absence of ring enhancement ( P = 0.03), and a proliferation index of 5.1% or lower ( P = 0.044) were independently associated with longer survival. The presence of an oligodendroglial component was associated with better prognosis in the univariate analysis ( P = 0.009), although this lost power in the multivariate analysis. CONCLUSIONS In addition to previously recognized prognostic variables such as age and KPS score, CT ring enhancement and tumor proliferation index were identified as independent predictors of survival in a homogeneous series of patients with anaplastic gliomas. Cancer 2003;97:1063–71. © 2003 American Cancer Society. DOI 10.1002/cncr.11120