Journal of Neuro-Oncology

, Volume 103, Issue 1, pp 103–110 | Cite as

Prognosis of oligodendroglial tumor with ring enhancement showing central necrotic portion

  • Ki-Young Choi
  • Tae-Young Jung
  • Shin Jung
  • Young-Hee Kim
  • Kyung-Sub Moon
  • In-Young Kim
  • Sam-Suk Kang
  • Kyung-Hwa Lee
Clinical Study – Patient Study


Oligodendroglial tumors sometimes show heterogeneous ring enhancement with a central necrotic portion. We aimed to reveal the prognosis of such tumors based on such radiologic findings and compare them to other prognostic factors. Participants were 32 patients with oligodendroglioma (17 oligodendrogliomas, 15 anaplastic oligodendrogliomas) who underwent surgery from 2004 to 2008. We investigated tumor radiologic findings, locations, calcification, whether localized or diffuse type, and enhancement patterns. Of other prognostic factors, we analyzed age, sex, pathology, extent of removal, adjuvant therapy, genetic change in 1p and 19q, and MGMT methylation status. We checked for genetic abnormality in 1p and 19q using the FISH method. To investigate MGMT methylation, we performed methylation-specific PCR (MSP). Mean follow-up duration was 3.2 years. Median age was 42.4 years, and the male:female ratio was 21:11. Out of 17 oligodendrogliomas, 14 (82.4%) showed combined 1p/19q deletion, and 14 (82.4%), methylated MGMT. Among 15 anaplastic oligodendrogliomas, there were 7 (46.6%) with combined 1p/19q deletion and 11 (73.3%) with methylated MGMT. The 4-year recurrence-free survival and overall survival were 77.6 and 100% in oligodendrogliomas and 59.1 and 71.6% in anaplastic oligodendrogliomas, respectively. On univariate analysis, radiologic variable of ring enhancement pattern was statistically significant related with recurrence-free survival (P = 0.003). Variables such as sex (P = 0.03), combined 1p/19q loss (P = 0.04), tumor location (P = 0.02), and anaplastic pathology (P = 0.04) were significantly correlated with overall survival. Cox’s regression model revealed that ring enhancement pattern was associated with frequent recurrence (ring enhancement, hazard ratio = 8.281, P = 0.04), and these showed 1p deletion only. Anaplastic oligodendrogliomas with ring enhancement like glioblastomas and without combined 1p/19q loss should receive close follow-up after treatment because of frequent recurrences.


MGMT Oligodendroglial tumors Prognosis Radiologic findings 1p and 19q 



This study was supported by a grant (CRI10067-1) from the Chonnam National University Hospital Research Institute of Clinical Medicine.


  1. 1.
    Reifenberger G, Louis DN (2003) Oligodendroglioma: toward molecular definitions in diagnostic neurooncology. J Neuropathol Exp Neurol 62:111–126PubMedGoogle Scholar
  2. 2.
    van den Bent M, Chinot OL, Cairncross JG (2003) Recent developments in the molecular characterization and treatment of oligodendroglial tumors. Neurooncology 5:128–138Google Scholar
  3. 3.
    Cairncross JG, Macdonald DR (1988) Successful chemotherapy for recurrent malignant oligodendroglioma. Ann Neurol 23:360–364PubMedCrossRefGoogle Scholar
  4. 4.
    Harris LC, Remack JS, Brent TP (1994) Identification of a 59 bp enhancer located at the first exon/intron boundary of the human O6-methylguanine DNA methyltransferase gene. Nucleic Acids Res 22:4614–4619PubMedCrossRefGoogle Scholar
  5. 5.
    Esteller M, Garcia-Foncillas J, Andion E, Goodman SN, Hidalgo OF, Vanaclocha V, Baylin SB, Herman JG (2000) Inactivation of the DNA-repair gene MGMT and the clinical response of lgiomas to alkylating agents. N Engl J Med 343:1350–1354PubMedCrossRefGoogle Scholar
  6. 6.
    Perry A, Fuller CE, Banerjee R, Brat DJ, Scheithauer BW (2003) Ancillary FISH analysis for 1p and 19q status: preliminary observations in 287 gliomas and oligodendroglioma mimics. Front Biosci 8:a1–a9PubMedCrossRefGoogle Scholar
  7. 7.
    Margain D, Peretti-Viton P, Perez-Castillo AM, Martini P, Salamon G (1991) Oligodendrogliomas. J Neuroradiol 18:153–160PubMedGoogle Scholar
  8. 8.
    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 90:1473–1479PubMedCrossRefGoogle Scholar
  9. 9.
    Reifenberger G, Kros JM, Burger P, Louis DN, Collins VP (2000) Oligodendroglioma. In: Kleihues P, Cavenee WK (eds) World Health Organization classification of tumours, pathology and genetics of tumours of the nervous system. IARC Press, Lyon, France, pp 56–67Google Scholar
  10. 10.
    Jung TY, Jung S, Lee KH, Cao VT, Jin SG, Moon KS, Kim IY, Kang SS, Kim HS, Lee MC (2010) Nogo-A expression in oligodendroglial tumors. Neuropathology. doi: 10.1111/j.1440-1789.2010.01118.x
  11. 11.
    Giannini C, Burger PC, Berkey BA, Cairncross JG, Jenkins RB, Mehta M, Curran WJ, Aldape K (2008) Anaplastic oligodendroglial tumors: refining the correlation among histopathology, 1p 19q deletion and clinical outcome in intergroup Radiation Therapy Oncology Group Trial 9402. Brain Pathol 18:360–369PubMedCrossRefGoogle Scholar
  12. 12.
    Cao VT, Jung TY, Jung S, Jin SG, Moon KS, Kim IY, Kang SS, Park CS, Lee KH, Chae HJ (2009) The correlation and prognostic significance of MGMT promoter methylation and MGMT protein in glioblastomas. Neurosurgery 65:866–875Google Scholar
  13. 13.
    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 90:1473–1479PubMedCrossRefGoogle Scholar
  14. 14.
    Chinot O (2001) Chemotherapy for the treatment of oligodendroglial tumors. Semin Oncol 4(Suppl 13):13–18CrossRefGoogle Scholar
  15. 15.
    Bigner SH, Matthews MR, Rasheed BK, Wiltshire RN, Friedman HS, Friedman AH, Stenzel TT, Dawes DM, McLendon RE, Bigner DD (1999) Molecular genetic aspects of oligodendrogliomas including analysis by comparative genomic hybridization. Am J Pathol 155:375–386PubMedCrossRefGoogle Scholar
  16. 16.
    Smith JS, Alderete B, Minn Y, Borell TJ, Perry A, Mohapatra G, Hosek SM, Kimmel D, O’Fallon J, Yates A, Feuerstein BG, Burger PC, Scheithauer BW, Jenkins RB (1999) Localization of common deletion regions on 1p and 19q in human gliomas and their association with histological subtype. Oncogene 18:4144–4152PubMedCrossRefGoogle Scholar
  17. 17.
    Ngo TT, Peng T, Liang XJ, Akeju O, Pastorino S, Zhang W, Kotliarov Y, Zenklusen JC, Fine HA, Maric D, Wen PY, De Girolami U, Black PM, Wu WW, Shen RF, Jeffries NO, Kang DW, Park JK (2007) The 1p-encoded protein stathmin and resistance of malignant gliomas to nitrosoureas. J Natl Cancer Inst 18:639–652Google Scholar
  18. 18.
    Fallon KB, Palmer CA, Roth KA, Nabors LB, Wang W, Carpenter M, Banerjee R, Forsyth P, Rich K, Perry A (2004) Prognostic value of 1p, 19q, 9p, 10q, and EGFR-FISH analyses in recurrent oligodendrogliomas. J Neuropathol Exp Neurol 63:314–322PubMedGoogle Scholar
  19. 19.
    Iwamoto FM, Nicolardi L, Demopoulos A, Barbashina V, Salazar P, Rosenblum M, Hormigo A (2008) Clinical relevance of 1p and 19q deletion for patients with WHO grade 2 and 3 gliomas. J Neurooncol 88:293–298PubMedCrossRefGoogle Scholar
  20. 20.
    Okamoto Y, Di Patre PL, Burkhard C, Horstmann S, Jourde B, Fahey M, Schuler D, Probst-Hensch NM, Yasargil MG, Yonekawa Y, Lutolf UM, Kleihues P, Ohgaki H (2004) Population-based study on incidence, survival rates, and genetic alterations of low-grade diffuse astrocytomas and oligodendrogliomas. Acta Neuropathol 108:49–56PubMedCrossRefGoogle Scholar
  21. 21.
    Weller M, Berger H, Hartmann C, Schramm J, Westphal M, Simon M, Goldbrunner R, Krex D, Steinbach JP, Ostertag CB, Loeffler M, Pietsch T, von Deimling A, German Glioma Network (2007) Combined 1p/19q loss in oligodendroglial tumors: predictive or prognostic biomarker? Clin Cancer Res 13:6933–6937PubMedCrossRefGoogle Scholar
  22. 22.
    Schiff D, Brown PD, Giannini C (2007) Outcome in adult low-grade glioma: the impact of prognostic factors and treatment. Neurology 69:1366–1373PubMedCrossRefGoogle Scholar
  23. 23.
    Dong SM, Pang JC, Poon WS, Hu J, To KF, Chang AR, Ng HK (2001) Concurrent hypermethylation of multiple genes is associated with grade of oligodendroglial tumors. J Neuropathol Exp Neurol 60:808–816PubMedGoogle Scholar
  24. 24.
    Mollemann M, Wolter M, Felsberg J, Collins VP, Reifenberger G (2005) Frequent promoter hypermethylation and low expression of the MGMT gene in oligodendroglial tumors. Int J Cancer 113:379–385PubMedCrossRefGoogle Scholar
  25. 25.
    El-Hateer H, Souhami L, Roberge D, Maestro RD, Leblanc R, Eldebawy E, Muanza T, Melancon D, Kavan P, Guiot MC (2009) Low-grade oligodendroglioma: an indolent but incurable disease? Clinical article. J Neurosurg 111(2):265–271PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Ki-Young Choi
    • 1
  • Tae-Young Jung
    • 1
    • 3
  • Shin Jung
    • 1
    • 3
  • Young-Hee Kim
    • 3
  • Kyung-Sub Moon
    • 1
    • 3
  • In-Young Kim
    • 1
    • 3
  • Sam-Suk Kang
    • 1
  • Kyung-Hwa Lee
    • 2
  1. 1.Department of NeurosurgeryChonnam National University Hwasun HospitalJeollanam-doRepublic of Korea
  2. 2.Departments of PathologyChonnam National University Hwasun HospitalGwangjuSouth Korea
  3. 3.Brain Tumor Research Laboratory, and Chonnam National University Research Institute of Medical SciencesChonnam National University Hwasun Hospital and Medical SchoolGwangjuSouth Korea

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