Prognostic Significance of Histologic and Cytometric Factors in Supratentorial Astrocytomas

Abstract

There is no agreement in the literature on selecting the principal parameters that contribute to explain the different outcomes in supratentorial astrocytomas. Hence, we designed a global study using morphologic parameters and DNA quantification measured by flow cytometry (FCM) and image analysis (IA) on 116 tumors contrasting the results with patients' survival in a univariate and multivariate study. In the Kaplan-Meier study besides the necrosis (p<0.0001) there were other parameters with significant prognostic value such as nuclear atypia (p=0.0001), presence of anaplastic large cells (p=0.0003) and the morphology of the tumor vessels (p=0.009). Proliferative parameters like mitotic index, cell density, the cell fraction in S phase or G2/M phase, and the proliferative phase measured by image analysis (IA) or ploidy patterns did not influence the prognosis. In the Cox's proportional hazards model the presence of necrosis remained as the only prognostic predictor (p=0.001) and increased 5.9 times the risk of mortality in gliomas.