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Overall Management > Astrocytic
Tumors /
Mixed Gliomas
/ Oligodendroglial
Tumors |
Staging and Prognosis
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Journal of Clinical Oncology, Vol 24, No 34 (December 1), 2006: pp.
5419-5426.
DOI: 10.1200/JCO.2006.08.1497
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Abstract |
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Significance of Necrosis in Grading of
Oligodendroglial Neoplasms: A Clinicopathologic and Genetic Study of
Newly Diagnosed High-Grade Gliomas
C. Ryan Miller, Christopher
P. Dunham, Bernd W. Scheithauer, Arie Perry
From the Divisions of
Neuropathology, Washington University School of Medicine, St Louis,
MO; Mayo Clinic, Rochester, MN; and the University of Calgary,
Calgary, Alberta, Canada -- Address reprint requests to Arie Perry,
MD, Division of Neuropathology, Department of Pathology and
Immunology, Washington University School of Medicine, 660 S Euclid,
Campus Box 8118, St Louis, MO 63110; e-mail: aperry@wustl.edu
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Purpose. High-grade gliomas
(HGGs; WHO grades 3-4) are highly diverse, with survival
times ranging from months to years.
WHO 2000 grading criteria for high-grade oligodendroglial
neoplasms [anaplastic oligoastrocytoma (AOA) and anaplastic
oligodendroglioma (AO)] remain subjective, and the
existence of grade 4 variants is controversial.
Patients and Methods.
Overall survival (OS) of 1,093 adult patients with a cerebral HGG
newly diagnosed between 1990 and 2005 was analyzed by univariate and
multivariate models for significance of the following factors: patient
age, surgery type, year of diagnosis, endothelial proliferation, necrosis,
oligodendroglial histology, treatment center, and chromosome
1p, 19q, 7p (EGFR), and 10q (PTEN) abnormalities by
fluorescence in situ hybridization (FISH).
Results. Necrosis was a
statistically significant predictor of poor OS on
univariate and multivariate analyses in AOA but not in AO.
Median OS for patients with necrotic AOA (22.8 months) was
significantly worse than for patients with non-necrotic AOA
(86.9 months; P < .0001) but was better than
conventional glioblastomas (9.8 months; P <
.0001).
In addition to patient age, the following were significant
independent prognostic factors (P ≤ .001):
grade and surgery type for the entire HGG cohort; modified grade
for AOA (3 v 4); and modified grade, 1p/19q codeletion status,
and oligodendroglial histology for the 586 HGGs analyzed by
FISH.
Conclusion.
Stratification of AOA, but not of pure AO, into grades 3 and 4
on the basis of necrosis is prognostically justified and is more
powerful than the current approach.
Both routine histology and genetic testing provide
independent, prognostically useful information.
Presented in part at the 42nd Annual
Meeting of the American Society of Clinical Oncology, June
2-6, 2006, Atlanta, GA.
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© 2006 American Society of Clinical
Oncology
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.JPG)
Abstract
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