Early prognostic factors related to progression and malignant transformation of low-grade gliomas

Jung, Tae‐Young; Jung, Shin; Moon, Jung-Ho; Kim, In-Young; Moon, Kyung‐Sub; Jang, Won Young

doi:10.1016/j.clineuro.2011.08.002

Cited by 48 publications

(43 citation statements)

References 24 publications

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“…Despite executed numerous studies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11), there are some questions about the extent of resection, thus determination of prognostic factors is important for selecting appropriate treatment approaches. In general, a more aggressive initial surgery of LGGs is estimated remarkable improvement in PFS and OS when compared with simple debulking but no randomised controlled researchs have been done yet (4,6,9,12). Maximum safe resection is also associated with a delay in malign transformation (4,9) but complete removal of extended tumors is usually not feasible as these tumors frequently diffuse into eloquent regions (13,14).…”

Section: Discussionmentioning

confidence: 99%

“…Surgery can be performed as gross total resection (GTR), subtotal resection (STR), partial resection (PR) or biopsy (BX). GTR is correlated with a delay in disease recurrence and malign transformation as well as with better survival outcomes (4,6,9). Radiotherapy (RT) indications are still controversial.…”

Section: Introductionmentioning

confidence: 99%

“…The median survival rate varies from 5 to 10 years (2,4) and the average 10-year survival is 30% (5). It's important to know prognostic factors for the decision of treatment, as they seen at young age and as they have long survey (6,7). The patient age, gender, performance status, tumor site, presence of seizure, tumor size, extent of surgery, histological subtype are the some prognostic factors (3,6,7).…”

Section: Introductionmentioning

confidence: 99%

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Prognostic factors for survival in adult patients with grade II glial tumors

Önder¹,

Kanyılmaz²,

Aktan³

et al. 2018

J Turgut Ozal Med Cent

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Aim: To investigate survival results of patients with low grade gliomas (LGGs) and to evaluate the predictive role of clinico-pathologic prognostic factors on survival. Material and Methods: Between 2003 and 2014, the adult patients with Grade II glial tumors were evaluated retrospectively. Several variables were investigated to find prognostic factors related with the overall survival (OS) and progression-free survival (PFS).Results: This study involved in 124 patients with median 40 (range; 6-132) months follow up. The average OS for the all patients was 7.8 years. 2-, 5-and 10-year OS ratios were 91%, 73% and 55%, respectively. Patients with low pignatti risk score had a longer OS than high pignatti risk score (p=0.01). Patients with seizure had a better OS (p=0.03). Patients with biopsy/partial resection had a poorer OS (p=0.02). Patients with residue after initial surgery had a worse OS (p=0.03). If the patients had recurrence or progression, the patients had poorer OS (p=0.01). Tumor with malignant transformation (p=0.01) and glioblastoma subtype after second surgery (p=0.003) had a poorer OS. The Pignatti risk score and seizure were the independent prognostic factors for PFS. Conclusion:The extent of surgery and recurrence or progression of Grade II glioma were the independent prognostic factors for OS. The Pignatti risk score and seizure were the independent prognostic factors for PFS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic factors for survival in adult patients with grade II glial tumors

Önder¹,

Kanyılmaz²,

Aktan³

et al. 2018

J Turgut Ozal Med Cent

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“…This variant has been shown to be more prone to malignant transformation and is associated with a shorter overall survival. 12,17,21,31,35 A study by Krouwer et al…”

Section: Discussionmentioning

confidence: 99%

Low-grade astrocytomas: the prognostic value of fibrillary, gemistocytic, and protoplasmic tumor histology

Babu

Bagley

Park

et al. 2013

JNS

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Object Low-grade astrocytomas are slow-growing, infiltrative gliomas that over time may progress into more malignant tumors. Various factors have been shown to affect the time to progression and overall survival including age, performance status, tumor size, and the extent of resection. However, more recently it has been suggested that histological subtypes (fibrillary, protoplasmic, and gemistocytic) may impact patient outcome. In this study the authors have performed a large comparative population-based analysis to examine the characteristics and survival of patients with the various subtypes of WHO Grade II astrocytomas. Methods Patients diagnosed with fibrillary, protoplasmic, and gemistocytic astrocytomas were identified through the Surveillance, Epidemiology, and End Results (SEER) database. The chi-square test and Student t-test were used to evaluate differences in patient and treatment characteristics between astrocytoma subtypes. Kaplan-Meier analysis was used to assess overall survival, and the log-rank test was used to evaluate the differences between survival curves. Univariate and multivariate analyses were also performed to determine the effect of various patient, tumor, and treatment variables on overall survival. Results A total of 500 cases were included in the analysis, consisting of 326 fibrillary (65.2%), 29 protoplasmic (5.8%), and 145 gemistocytic (29%) variants. Gemistocytic astrocytomas presented at a significantly older age than the fibrillary variant (46.8 vs 37.7 years, p < 0.0001), with protoplasmic and fibrillary subtypes having a similar age. Although protoplasmic and fibrillary variants underwent radiotherapy at similar rates, gemistocytic tumors more frequently received radiotherapy (p = 0.0001). Univariate analysis revealed older age, larger tumor size, and the use of radiotherapy to be poor prognostic factors, with resection being associated with improved survival. The gemistocytic subtype (hazard ratio [HR] 1.62 [95% CI 1.27–2.07], p = 0.0001) also resulted in significantly worse survival than fibrillary tumors. Bivariate analyses demonstrated that older age, the use of radiotherapy, and resection significantly influenced median survival. Tumor subtype also affected median survival; patients who harbored gemistocytic tumors experienced less than half the median survival of fibrillary and protoplasmic tumors (38 vs 82 months, p = 0.0003). Multivariate analysis revealed increasing age (HR 1.05 [95% CI 1.04–1.05], p < 0.0001), larger tumor size (HR 1.02 [95% CI 1.01–1.03], p = 0.0002), and the use of resection (HR 0.70 [95% CI 0.52–0.94], p = 0.018) to be independent predictors of survival. Examination of tumor subtype revealed that the gemistocytic variant (HR 1.30 [95% CI 0.98–1.74], p = 0.074) was associated with worse patient survival than fibrillary tumors, although this only approached significance. The protoplasmic subtype did not affect overall survival (p = 0.33). Conclusions Gemistocytic tumor histology was associated with worse survival than fibrillary and protoplasmic astrocytomas. As protoplasmic astrocytomas have a survival similar to fibrillary tumors, there may be limited utility to the identification of this rare variant. However, increased attention should be paid to the presence of gemistocytes in low-grade gliomas as this is associated with shorter time to progression, increased malignant transformation, and reduced overall survival.

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“…8,18,20 However, LGGs are a serious pathological entity because of where they can occur and their potential to dedifferentiate into malignant glioma. 12,23 Although some authors have advocated a conservative watchful waiting approach to LGGs, 3,4 there is growing consensus that GTR soon after presentation produces the greatest benefit for progression-free and overall survival. 7,11,13,14,19,22 Not all LGGs are identical, however.…”

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confidence: 99%

Improved survival in the largest national cohort of adults with cerebellar versus supratentorial low-grade astrocytomas

Bagley¹,

Babu²,

Friedman³

et al. 2013

FOC

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Object Low-grade gliomas (LGGs) are indolent tumors that have the potential to dedifferentiate into malignant high-grade tumors. Recent studies have demonstrated that cerebellar low-grade tumors have a better prognosis than supratentorial tumors, although no study has focused on the risk factors for poor prognosis in cerebellar LGGs in adults. The authors of the current study aimed to address both of these concerns by using a large cohort derived from a national cancer registry and a smaller cohort derived from their institution's experience. Methods Adults with diagnosed Grade I and Grade II gliomas of the cerebellum were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate Cox proportional hazard models were used to predict rates of survival, and the log-rank test was applied to evaluate differences in Kaplan-Meier survival curves. An institutional cohort was created by isolating all patients whose surgical pathology revealed an LGG of the cerebellum. Excluded from analysis were patients in whom a glioma was first diagnosed under the age of 18 years and those whose tumors could not be definitively determined to arise from the cerebellum. Results Data from the local cohort (11 patients) demonstrated that the most common presenting symptom was headache, which occurred in more than 70% of the cohort. Approximately half of the patients in this cohort had symptomatic improvement after treatment. Results from the SEER cohort (166 patients) revealed that adults with Grade I gliomas were slightly younger than those with Grade II tumors (p < 0.01), but no other demographic differences were observed. Patients with Grade I tumors were twice as likely to undergo gross-total resection (54% vs 21%), and those with Grade II gliomas were much more likely to receive postoperative radiation (3% vs 48%). Five-year survival was greater in the patients with Grade I gliomas than in those with Grade II lesions (91% vs 70%). Multivariate analysis revealed that an age ≥ 40 years (HR 7.30, 95% CI 3.55–15.0, p < 0.0001) and Grade II tumors (HR 2.76, 95% CI 1.12–6.84, p = 0.028) were risk factors for death, whereas female sex was protective (HR 0.28, 95% CI 0.14–0.59, p < 0.001). Log-rank tests revealed that a cerebellar location was protective (p < 0.0001), but this relationship was only true for Grade II tumors (p < 0.0001). Survival in patients with Grade I gliomas was not different based on the various lesion locations (p = 0.21). Conclusions Taken together, adults with cerebellar WHO Grade I and II astrocytomas have a much more favorable survival curve than those with similar supratentorial tumors. Research demonstrates that the primary driver of this phenomenon is the improved survival in patients with cerebellar Grade II gliomas.

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Early prognostic factors related to progression and malignant transformation of low-grade gliomas

Cited by 48 publications

References 24 publications

Prognostic factors for survival in adult patients with grade II glial tumors

Prognostic factors for survival in adult patients with grade II glial tumors

Low-grade astrocytomas: the prognostic value of fibrillary, gemistocytic, and protoplasmic tumor histology

Improved survival in the largest national cohort of adults with cerebellar versus supratentorial low-grade astrocytomas

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