The presence of necrosis and/or microvascular proliferation does not influence survival of patients with anaplastic oligodendroglial tumours: review of 98 patients
- 73 Downloads
Accurate prognosis for patients with anaplastic oligodendroglial gliomas is increasingly difficult to make. Characterisation of these tumours remains challenging, increasing proportions of oligodendroglial diagnoses in gliomas are reported, and no WHO 2000 grade IV exists for them, so that highly anaplastic tumours can only be grouped with glioblastoma (GBM) or with grade III oligodendroglioma, which have differing clinical behaviour. Longer survival times reported for patients with glioblastoma containing an oligodendroglial element (GBMO) suggest that a grade IV for oligodendroglial tumours might exist.
In patients with anaplastic gliomas containing an oligodendroglial element, we explored whether microvascular proliferation (MVP) and necrosis were associated with shorter survival, sufficient to create a grade IV. Biopsies for 98 patients with anaplastic oligodendroglioma, anaplastic oligoastrocytoma or tumours with an oligodendroglial and GBM element, discharged 1998–2004, were identified from databases at three allied neurosurgery units. Pathology reports were reviewed for the presence of MVP and necrosis. Anaplastic oligoastrocytoma and GBMO were combined to measure the effect of an astrocytic element on survival.
For anaplastic oligodendroglioma patients, median survival time was 24 months, while for anaplastic oligoastrocytoma or GBMO patients, it was 9 months. Age 60 or over (P = 0.006) and astrocytic element (P = 0.01) were the only independent predictors of survival. Patients 60 and over with an astrocytic element had 4.6 times the risk of death of patients under 60 with anaplastic oligodendroglioma.
A grade IV cannot be created using necrosis or MVP since neither feature predicted survival after adjustment for age and an astrocytic element. However age and an astrocytic element were strong predictors of poorer survival in patients with anaplastic oligodendroglial tumours.
KeywordsGlioblastoma Glioblastoma with oligodendroglial element Microvascular proliferation Oligoastrocytoma Oligodendroglioma Prognosis Survival analysis Tumour grading Tumour necrosis
Unable to display preview. Download preview PDF.
The assistance of Drs J. Fryer and C.␣McKenzie, Department of Anatomical Pathology, Royal North Shore Hospital, St. Leonards, NSW Australia is gratefully acknowledged.
This work was funded by a grant from the Andrew Olle Memorial Trust.
- 1.He J, Mokhtari K, Sanson M, Marie Y, Kujas M, Huguet S, Leuraud P, Capelle L, Delattre JY, Poirier J, Hoang-Xuan K (2001) Glioblastomas with an oligodendroglial component: a pathological and molecular study. J Neuropathol Exp Neurol 60:9863–9871Google Scholar
- 2.Perry A (2001) Oligodendroglial neoplasms: current concepts, misconceptions, and folklore. Adv Anat Pathol 8:4183–4199Google Scholar
- 3.Cairncross JG, Louis DL(2000): Molecular diagnosis of anaplastic oligodendroglioma subtypes. Neuro-Oncol 254(abstr)Google Scholar
- 5.Cairncross JG, Ueki K, Zlatescu MC, Lisle DK, Finkelstein DM, Hammond RR, Silver JS, Stark PC, Macdonald DR, Ino Y, Ramsay DA, Louis DN (1998) Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst 90:191473–191479CrossRefGoogle Scholar
- 6.Kleihues P, Cavenee WK (2000) Pathology & Genetics of Tumours of the Nervous System. IARC Press, LyonGoogle Scholar
- 7.Kraus JA, Wenghoefer M, Schmidt MC, von Deimling A, Berweiler U, Roggendorf W, Diete S, Dietzmann K, Muller B, Heuser K, Reifenberger G, Schlegel U (2000) Long-term survival of glioblastoma multiforme: importance of histopathological reevaluation. J Neurol 247:6455–6460Google Scholar
- 8.Donahue B, Scott CB, Nelson JS, Rotman M, Murray KJ, Nelson DF, Banker FL, Earle JD, Fischbach JA, Asbell SO, Gaspar LE, Markoe AM, Curran W (1997) Influence of an oligodendroglial component on the survival of patients with anaplastic astrocytomas: a report of radiation therapy oncology group 83–02. Int J Radiat Oncol Biol Phys 38:5911–5914CrossRefGoogle Scholar
- 9.Mueller W, Hartmann C, Hoffmann A, Lanksch W, Kiwit J, Tonn J, Veelken J, Schramm J, Weller M, Wiestler OD, Louis DN, von DA (2002) Genetic signature of oligoastrocytomas correlates with tumor location and denotes distinct molecular subsets. Am J Pathol 161:1313–1319Google Scholar
- 10.Zlatescu MC, TehraniYazdi A, Sasaki H, Megyesi JF, Betensky RA, Louis DN, Cairncross JG (2001) Tumor location and growth pattern correlate with genetic signature in oligodendroglial neoplasms. Cancer Res 61:186713–186715Google Scholar
- 13.Microsoft Corporation. Microsoft Office Professional. XP. 2003. Redmond, WA, USA. Ref Type: Computer ProgramGoogle Scholar
- 14.SAS Institute. SAS system for Windows. [v.8.00]. 1999. Cary, NC, USA. Ref Type: Computer ProgramGoogle Scholar
- 15.Scheithauer BW (2004) Oligodendroglioma and ‘mixed’ oligoastrocytoma. Pathol Int 54(Suppl.1):S376–S382Google Scholar
- 16.Daumas-Duport C, Tucker ML, Kolles H, Cervera P, Beuvon F, Varlet P, Udo N, Koziak M, Chodkiewicz JP (1997) Oligodendrogliomas. part II: a new grading system based on morphological and imaging criteria. J Neurooncol 34:161–178Google Scholar
- 17.Daumas-Duport C, Varlet P, Tucker ML, Beuvon F, Cervera P, Chodkiewicz JP (1997) Oligodendrogliomas. part I: patterns of growth, histological diagnosis, clinical and imaging correlations: a study of 153 cases. J Neurooncol 34:137–159Google Scholar
- 18.Giannini C, Scheithauer BW, Weaver AL, Burger PC, Kros JM, Mork S, Graeber MB, Bauserman S, Buckner JC, Burton J, Riepe R, Tazelaar HD, Nascimento AG, Crotty T, Keeney GL, Pernicone P, Altermatt H (2001) Oligodendrogliomas: reproducibility and prognostic value of histologic diagnosis and grading. J Neuropathol Exp Neurol 60:3248–3262Google Scholar
- 19.Mork SJ, Halvorsen TB, Lindegaard KF, Eide GE (1986) Oligodendroglioma. Histologic evaluation and prognosis. J Neuropathol Exp Neurol 45:165–178Google Scholar
- 21.Ueki K, Nishikawa R, Nakazato Y, Hirose T, Hirato J, Funada N, Fujimaki T, Hojo S, Kubo O, Ide T, Usui M, Ochiai C, Ito S, Takahashi H, Mukasa A, Asai A, Kirino T (2002) Correlation of histology and molecular genetic analysis of 1p, 19q, 10q, TP53, EGFR, CDK4, and CDKN2A in 91 astrocytic and oligodendroglial tumors. Clin Cancer Res 8:1196–1201Google Scholar
- 23.Burger PC, Rawlings CE, Cox EB, McLendon RE, Schold SC, Jr., Bullard DE (1987) Clinicopathologic correlations in the oligodendroglioma. Cancer 59:71345–71352Google Scholar
- 26.Kleihues P, Louis DN, Scheithauer BW, Rorke LB, Reifenberger G, Burger PC, Cavenee WK (2002) The WHO classification of tumors of the nervous system. J Neuropathol Exp Neurol 61:3215–3225Google Scholar
- 28.Fortin D, Cairncross GJ, Hammond RR (1999) Oligodendroglioma: an appraisal of recent data pertaining to diagnosis and treatment. Neurosurgery 45:61279–61291Google Scholar