[Prognosis of gliomas].
In a given patient harbouring a glioma, prognosis is simply a question of survival duration rather than projecting the course of illness. The marked variability among glioma patients is due to prognosis factors. That are currently divided into four broad categories: characteristics of the host, characteristics of the tumor, factors related to the influence of the tumor on the host and factors related to treatment. For astrocytomas the three factors most closely related to duration of survival are age, functional status and histological grading. Age is fundamental because it underlies histological grade, functional status, accessibility for treatment and therapeutical responses Histological grading can now be evaluated with features actually correlated with duration of survival. Clinical examination should be recorded using functional scales that more precisely reflect the influence of the tumor on the host than simple clinical signs. Morphological data provided by neuroradiology, such as correct localization or existence of a mass effect provide supplementary prognosis factors. The identification, knowledge and quantification of prognostic factors and their influence are important and useful for understanding the natural history of the disease, to predict the expected survival for individual patient and to evaluate the beneficial effects of treatments. In spite of much work dealing with gliomas, several questions remain to be answered. The role of treatments in grade II astrocytomas is, for example, matter of debate. In malignant gliomas, surgical resection could improve the quality of survival, radiation therapy the duration of survival and chemotherapy the rate of survivors at one and two years. However, many questions are still unanswered. The utility of data from the literature is limited, partly due to flaws in the application of statistical methods, and partly to wide differences in histological and clinical selection criteria. Progress in the field of glioma prognosis is more likely to emerge from purely biological tumor research than from clinical studies.
Loiseau
H
H
Clinique Universitaire de Neurochirurgie, Hôpital Pellegrin-Tripode, Bordeaux.
D005910:Glioma / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D011379:Prognosis
Pronostic des gliomes.