Prognostic Factors for Survival in Adult Patients With Cerebral Low-Grade Glioma

Abstract

P r o g n o s t i c F a c t o r s f o r S u r v i v a l i n A d u l t P a t i e n t s W i t h C e r e b r a l L o w -G r a d e G l i o m aPurpose: To identify prognostic factors for survival in adult patients with cerebral low-grade glioma (LGG), to derive a prognostic scoring system, and to validate results using an independent data set.Patients and Methods: European Organization for Research and Treatment of Cancer (EORTC) trial 22844 and EORTC trial 22845 are the largest phase III trials ever carried out in adult patients with LGG. The trials were designed to investigate the dosage and timing of postoperative radiotherapy in LGG. Cox analysis was performed on 322 patients from EORTC trial 22844 (construction set), and the results were validated on 288 patients from trial 22845 (validation set). Patients with pilocytic astrocytomas were excluded from this prognostic factor analysis.Results: Multivariate analysis on the construction set showed that age > 40 years, astrocytoma histology subtype, largest diameter of the tumor > 6 cm, tumor crossing the midline, and presence of neurologic deficit before surgery were unfavorable prognostic factors for survival. The total number of unfavorable factors present can be used to determine the prognostic score. Presence of up to two of these factors identifies the lowrisk group, whereas a higher score identifies high-risk patients. The validity of the multivariate model and of the scoring system was confirmed in the validation set.Conclusion: In adult patients with LGG, older age, astrocytoma histology, presence of neurologic deficits before surgery, largest tumor diameter, and tumor crossing the midline were important prognostic factors for survival. These factors can be used to identify lowrisk and high-risk patients. L OW-GRADE GLIOMAS (LGGs) are in general relatively slow-growing primary brain tumors, but they have a very heterogeneous clinical behavior. Many patients present with seizures only and remain stable for a prolonged period of time, whereas others present with functional deficits or signs of increased intracranial pressure that necessitate prompt surgical treatment. The best treatment policy for these tumors is still unclear. Some physicians advocate early and extensive surgery or early radiation therapy, 1-3 whereas others tend to postpone treatment until functional deficits are present. [1][2][3][4] Several studies have attempted to identify prognostic factors in LGG. 1,[5][6][7][8][9][10][11][12] Prognostic factors have various applications that could be of particular value in the heterogeneous population of LGG. This includes guidance for stratification in phase III trials and ultimately for treatment in individual patients. However, except for age, the importance of other prognostic factors for survival in LGG remains a matter of debate, and the need for validated prognostic factors has not been resolved. A number of patient and tumor characteristics, such as age at diagnosis, performance status, histology subtype, primary tumor classification (T clas...

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“…The cutoff value of 40 years was chosen based on the median age of the study population (34 years) and on recently reported results from a series of patients with low-grade glioma. 32,33 Age was not identified as a prognostic factor by Guyotat et al, 15 who chose a different cutoff point; Guyotat et al actually observed a difference in survival that was similar to the one reported in the current series (16%), but the difference was not statistically significant, probably due to the limited number of patients or the lack of stratification. In the series investigated by Guyotat et al, 15 older patients had a higher rate of infratentorial tumors, Grade 2 histology, and macroscopic total resection compared with younger patients; these characteristics confounded the impact of age on survival.…”

Cerebral Blood Volume Measurements by Perfusion-Weighted MR Imaging in Gliomas: Ready for Prime Time in Predicting Short-Term Outcome and Recurrent Disease?

“…Another limitation is that our study lacks results regarding the predictive role of age, sex, tumor volume, and treatment protocols. Our choice not to analyze these parameters was justified by the small population size (the significance level of the multiple regression analysis including all these factors was P ϭ .08) and the diverse results found regarding age and sex in the literature, 11,17 whereas the predictive role of different treatment protocols has been demonstrated in recent larger studies.…”

“…10,17 It was recently shown that rCBV may be able to distinguish the stable from the rapidly progressing gliomas among patients with the same histopathologic grade (WHO grade II). 10 Considering the results from 2 previous studies, 7,10 we conducted an investigation that included all patients with primary brain tumors, with the histologic diagnosis of glioma as the only requirement.…”

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“…16 This relationship is perhaps best exemplified by the fact that patients with LGG rarely present with neurological deficits. 36 Moreover, mapping studies in patients with LGG demonstrate multiple patterns of reorganization and compensation, including identifying function persisting within the tumor or redistributed immediately around the tumor, throughout the ipsilateral hemisphere, or into the contralateral hemisphere. 16 In all cases, patients seemingly have no deficit.…”