Affiliation:
1. 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
Abstract
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.
Publisher
American Society of Clinical Oncology (ASCO)
Reference23 articles.
1. Central Brain Tumor Registry of the United States: Statistical Report: Primary Brain Tumors in the United States, 1998-2002 . Hinsdale, IL, Central Brain Tumor Registry of the United States, 2006
2. Kleihues P, Cavenee WK: International Agency for Research on Cancer: Pathology and Genetics of Tumours of the Nervous System . Lyon, France, International Agency for Research on Cancer Press, 2000
3. Discrepancies in diagnoses of neuroepithelial neoplasms
4. Improving diagnostic accuracy and interobserver concordance in the classification and grading of primary gliomas
5. Interobserver reproducibility among neuropathologists and surgical pathologists in fibrillary astrocytoma grading
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