Correlates of survival and the Daumas-Duport grading system for astrocytomas

Abstract

In order to examine the correlation between prognosis and the histological features of nuclear atypia, mitosis, endothelial proliferation, and necrosis in supratentorial adult astrocytomas, the authors reviewed 251 such cases treated at the Massachusetts General Hospital between 1972 and 1980. One point was given for the presence of each feature. The total number of features was translated into a grade as follows: none of the four features = Grade 1 (one patient), one feature = Grade 2 (36 patients), two features = Grade 3 (33 patients), and three or four features = Grade 4 (181 patients). The period of survival was significantly associated with grade, the presence or absence of each of the four histological features, patient's age, type of operation, radiation therapy, and extent of tumor (log rank, p less than 0.05). The variables associated with grade were age (p less than 0.001) and radiation therapy (p less than 0.02). After adjustment for these variables using a Cox proportional-hazards model, the difference in overall survival time between patients in Grades 2 and 3 was not statistically significant. When comparable groups of patients were examined in terms of age or receipt of radiation therapy, the median survival times differed markedly. Patients 50 years of age or less had a median survival time of 68 months (Grade 2 tumors), 29 months (Grade 3 tumors), and 13 months (Grade 4 tumors). Patients over 50 years of age had a median survival time of 6 months (Grade 2 and 4 tumors) and 9 months (Grade 3 tumors). Those patients who had received radiation therapy had a median survival time of 68 months (Grade 2 tumors), 21 months (Grade 3 tumors), and 11 months (Grade 4 tumors). Those patients who did not receive radiation therapy had a median survival time of 1 month (Grade 2 tumors) and 2 months (Grade 3 and 4 tumors); over half of these patients died within 2 months of surgery. This grading system, originally proposed by Daumas-Duport, et al., is simple, objective, and reproducible, and correlates well with survival times. The authors recommend that astrocytomas be graded on a scale of 1 to 4, with Grade 1 reserved for the rare adult supratentorial astrocytoma with none of the four histological features.

Analysis of the activation status of Akt, NFκB, and Stat3 in human diffuse gliomas

“…The median survival for LGA is greater than 5 years, compared to 2-5 years for AA, and less than 1 year for GBM. [2][3][4] Many alterations in the genes that regulate normal homeostasis of cell proliferation, differentiation, and apoptosis contribute to the formation and progression of diffuse gliomas. 1 Among these genetic lesions, amplification of the epidermal growth factor receptor (EGFR) gene and mutation or deletion of the phosphatase and tensin homolog (PTEN) gene occur in 40-50% of high-grade gliomas, particularly in primary GBM.…”

Astrocytomas and Prognosis-From Morphology to Tumor Biology

“…Astrocytomas can affect any age group ranging from infancy to old age with a mean age ranging from 46 to 53.5 years [3,9,10], and our cases with a mean age of 41.26 years, were similar in distribution. Behaviorally, benign astrocytomas are known to occur earlier than malignant astrocytomas [1OJ and the same held true in our study also, the average age of lower grade astrocytomas (I-II) was 31.0 years and for higher grade (III-IV) it was 50.78 years, the difference between the two being highly significant.…”

“…The usefulness has been amply demonstrated in a large series by Kim et al [10] who found the following incidence of the various grades of astrocytoma : grade I (0.4%), grade II (14.34%), grade III (13.14%), and grade IV (72.11 %) in 251 patients. On the other hand Wang and Ho (11] found the incidence of the same grades to be 9.2%, 26.2%, 36.9% and 27.6% respectively.…”

The Alpha-Lactalbumin/Oleic Acid Complex and Its Cytotoxic Activity

“…Gliomas are a heterogeneous group of intracranial neoplasms originating from neuroglial cells, which accounts for over 60% of all primary brain tumors and have an unfavorable prognosis [110][111][112][113]. Glioblastoma multiforme (GBM), grade IV on the current WHO grading-scale for tumors in the central nervous system, is the most malignant of the gliomas, showing a mean survival time of less than a year [113,114].…”